All in the Family
We present a patient, with a familial clustering of autoimmune/collagen vascular diseases, who was found to have a prolactinoma and multiple autoimmune disorders.
A 47 year old male presented with 6 month history of bifrontal and occipital headaches associated with diplopia and blurry vision. He also had decreased libido and erectile dysfunction. Family history included non-Hodgkin’s lymphoma, Addison’s disease and celiac disease, hypothyroidism, SLE, and RA. On physical exam, he had right lateral gaze diplopia, bitemporal hemianopia and vitiligo. CT and MRI of the head showed an infiltrative sellar mass of 62x42x50mm extending into the cavernous sinus that encased both carotid arteries. Serum prolactin was 13837.4 ng/ml(1.8-14.4),ACTH 21pg/ml(6-48),GH 0.7 ng/ml(0.0-6.0),IGF-1 312ng/ml(94-252),LH 0.9 mIU/ml(1.5-9.3),FSH 2.5 mIU/ml(0.9-15.0),testosterone 95 ng/dL(241-827),TSH1.11 uIU/mL(0.3-5.5),random cortisol 6 mcg/dL(>2.5),AM cortisol 19.5mcg/dL(4.3-22.4). Given the family history of celiac disease and presence of vitiligo, patient screening for celiac disease was positive. Following treatment with bromocriptine; headache and visual symptoms completely resolved, sexual performance improved and imaging showed interval improvement of the mass.
Prolactin (PRL) is a pituitary hormone which also acts as a cytokine involved in immune response. PRL has immune modulatory effect. Hyperprolactinemia (HPRL) has been described in the active phase of some non organ-specific autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and organ-specific autoimmune diseases, such as celiac disease, type 1 diabetes mellitus, Addison's disease, and autoimmune thyroid diseases. Data has shown correlation between PRL levels and disease activity in diseases like SLE, RA and celiac disease but results have been inconsistent. The role of dopamine agonists in treatment of autoimmune diseases is yet to be determined. It is interesting to note that our patient had hyperprolactinemia, due specifically to prolactinoma, along with the autoimmune diseases and a significant family history of autoimmune diseases.
HPRL is observed in various autoimmune diseases. Further research into the effects of PRL and the monitoring of patients with hyperprolactinemia and autoimmune diseases will provide guidance on how to best utilize the potentially deleterious effects of prolactin and the benefits of dopamine agonists.
Published In/Presented At
Shaik, S. Dhamdhere, M. Arastu, M. Leh, D. (2013, June 17). All in the Family. Presentation Presented at: ENDO The Endocrine Society 95th Annual Meeting, San Francisco, California.
Endocrinology, Diabetes, and Metabolism | Internal Medicine
Department of Medicine, Department of Medicine Faculty