Synchronous Endometrial Carcinoma and a Macroprolactinoma: Exploring a Causal Relationship

Abstract

Background: While unopposed estrogen hormone secretion is most commonly implicated in the pathogenesis of endometrial carcinoma, the role of prolactin has only recently been highlighted. The authors present a case of a synchronous endometrial carcinoma in a patient with a prolactin-secreting macroadenoma. Methods: A 29-year-old woman presented with a 4-year history of primary infertility, irregular periods and intermittent galactorrhea. Hormonal evaluation revealed elevated prolactin and subnormal luteinizing hormone and follicle-stimulating hormone (FSH) serum concentrations. An ultrasound of the pelvis revealed endometrial thickening. The MRI of the brain confirmed a pituitary macroadenoma. The patient underwent a resectoscopic polypectomy and dilation and curettage followed by transnasal transsphenoidal excision of the pituitary macroadenoma. Results: The biopsy of the endometrium revealed a well-differentiated endometrioid carcinoma while that of the pituitary tumor confirmed a prolactinoma. Conclusion: An indirect causal mechanism can be postulated to explain this association. Hyperprolactinemia inhibits gonadotropin-releasing hormone leading to subnormal FSH and luteinizing hormone levels. Though the patient is hypoestrogenic, chronic anovulation with unopposed estrogen secretion can increase the risk of endometrial carcinoma. Patients with prolactinomas and irregular menstrual bleeding should undergo endometrial sampling to rule out this possibility.

Endometrioid Endometrial Carcinoma Indirectly Caused by Pituitary Prolactinoma:A Case Report

“…Pituitary prolactinoma could thus have indirectly resulted in endometrioid endometrial carcinoma through chronic anovulatory cycle in this case. Indeed, some anecdotal evidence from similar cases suggests a relationship between hyperprolactinemia and endometrioid carcinoma [10–12]. In this case, obesity could also have been a cause of ovulatory disorder, in addition to pituitary prolactinoma.…”

“…Obesity is thought to have various carcinogenic effects other than ovulatory disorder for endometrial carcinoma [7]. However, cases of endometrial carcinoma correlating with hyperprolactinemia have involved younger patients compared to the more common obese cases without hyperprolactinemia [10, 12]. Pituitary prolactinoma could thus have been more important than obesity as a cause of carcinoma in this case.…”

The Relevant Participation of Prolactin in the Genesis and Progression of Gynecological Cancers

“…Since PRL is recognized as a biomarker (93,100), poor prognosis marker (95), risk factor (49,(105)(106)(107), and has even been proposed as a potential therapeutic target (2,43) for EC, it would be fascinating to carry out clinical studies in which the interaction of PRL with PRLR is blocked to confirm the evidence shown by the various working groups that propose PRL as a critical factor in the progression of this type of neoplasia.…”