Normalization of Androgen and Sex Hormone-Binding Globulin Levels after Treatment of Hyperprolactinemia

Abstract

Twenty-eight women with amenorrhea, galactorrhea and hyperprolactinemia without hirsutism were studied before and after bromocriptine therapy for 2 months. Compared to 15 euprolactinemic controls, hyperprolactinemic women had elevated levels of dehydroepiandrosterone sulfate and androstenedione and lower levels of total testosterone (T), and androst-5-ene-3 beta, 17 beta-diol (Adiol), and 17 beta-estradiol (P less than 0.05). Unbound T and unbound Adiol were significantly elevated, while sex hormone-binding globulin binding capacity was decreased (P less than 0.05) and corticosteroid-binding globulin binding capacity was normal. After treatment with bromocriptine, dehydroepiandrosterone sulfate and androstenedione decreased to control levels, as did unbound Adiol, while 17 beta-estradiol and sex hormone-binding globulin binding capacity levels increased significantly (P less than 0.05). Five hyperprolactinemic women underwent ACTH stimulation tests before and after treatment, and the results were compared to those of seven controls. Steroid ratios in response to ACTH suggested normal 3 beta ol-dehydrogenase-isomerase, 17-20-desmolase and 17 beta-hydroxysteroid dehydrogenase enzymatic activities in hyperprolactinemia. Basal steroid ratios of T to 5 alpha-androstane-17 beta-01-3-one) (DHT) and of unbound T to unbound dihydrotestosterone were elevated (P less than 0.05), suggesting reduced 5 alpha-reductase activity in hyperprolactinemia which is normalized after treatment. Hirsutism was not present in these patients with hyperprolactinemia despite elevated levels of unbound T and Adiol, and may be explained by reduced 5 alpha-reductase activity. Our data suggest that the increased levels of androgens in these patients result from the hyperprolactinemia.

Endocrinological and Clinical Analysis of Hyperprolactinemic Patients with and without Ultrasonically Diagnosed Polycystic Ovarian Changes

“…The main effect of PRL on androgen metabolism is probably modulated through the adrenal gland and a synergism is present in action with ACTH; however, no specific enzymatic block was documented [9,10]. In addi tion, it was postulated that hyperprolactinemia was asso ciated with decreased sex hormone binding levels [9], In our study, DHEAS levels were in the upper limits of nor mal range in both groups which may be due to the abovementioned effects of PRL.…”

“…In addi tion, it was postulated that hyperprolactinemia was asso ciated with decreased sex hormone binding levels [9], In our study, DHEAS levels were in the upper limits of nor mal range in both groups which may be due to the abovementioned effects of PRL. No statistically significant dif ference was present between the two groups.…”

Hyperprolactinémie et fonction sexuelle chez l’homme

“…Ces m~canismes ind6pendants de la testosterone peuvent inclure la diminution de sa 5 alpha reduction en dihydrotestosterone rapport6s par Lobo et Kletzky [27] chez les hommes HPRL, puisque la dihydrotestost~rone semble le principal metabolite responsable des effets de la testosterone sur le cerveau des primates. Mais les plus importants se situent probablement au niveau d'interactions entre taux ~lev6s de PRL et syst6mes de neurotransmetteurs.…”

Hyperprolactinemia and Sexual Function in Men

“…Similar data were previously reported [5. 10, 22], In addition, plasma sex hormone binding globulin (SHBG) has been reported to be lowered in HPRL patients [16,29], Therefore, the effects of low total testoster one levels ought to be attenuated by an in crease of the proportion of unbound testos terone.…”

“…Both experimental [17] and pathological [15,16,18] HPRL have been reported to decrease the 5a reduction of testosterone into dihydroteslosterone (DHT). This could act in the sexual disturbances of HPRL males, since DHT seems to be the main metabolite ac countable for the effects of testosterone upon nervous centers in primates [20].…”