Ectopic prolactin secretion from a gonadoblastoma

Hoffman, William H.; Gala, Richard R.; Kovács, Kálmán; Subramanian, Marappa G.

doi:10.1002/1097-0142(19871201)60:11<2690::aid-cncr2820601119>3.0.co;2-j

Cited by 49 publications

(24 citation statements)

References 38 publications

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“…The predominant form in healthy subjects and in patients with prolactinomas is monomeric PRL (molecular mass 23 kDa), while dimeric or big PRL (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60), and big-big PRL or macroprolactin (150-170 kDa) correspond to less than 20% of the total PRL (13)(14)(15). When the serum of a patient with hyperprolactinemia contains mostly macroprolactin, the condition is termed macroprolactinemia (16,17).…”

Section: Prolactin Serum Isoformsmentioning

confidence: 99%

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

112

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The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22 Keywords Hyperprolactinemia; diagnostic pitfalls; hook effect; macroprolactinemia; pituitary incidentalomas RESUMO A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve--se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outr...

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Section: Prolactin Serum Isoformsmentioning

confidence: 99%

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

112

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“…PRL has also been implicated in the onset and progression of mammary cancer in rodents and humans [2]. PRL is secreted not only by lactotrophic cells of the pituitary gland but also by a variety of other normal tissues and human tumors [3] including malignant tumors of the lung [4], kidney [5], uterine cervix [6], prostate, and ovary [7]. Expression of the PRL gene is regulated by many factors, including cAMP, estradiol, phorbol esters, epidermal growth factor, thyrotropin-releasing hormone, and insulin [8].…”

Section: Introductionmentioning

confidence: 99%

Expression of functional prolactin and its receptor in human colorectal cancer

Otte

Beckedorf

et al. 2003

International Journal of Colorectal Disease

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Section: Ectopic Prolactin (Prl) Production By Tumorsmentioning

confidence: 99%

“…Prevalence, Presentation and Diagnosis: Prolactin was found to be ectopically produced by several cancers including malignant tumours of the lung, kidney, uterine, ovary, breast and colorectal cancer [115,[119][120][121][122][123][124][125].…”

Section: Ectopic Prolactin (Prl) Production By Tumorsmentioning

confidence: 99%

“…It was even found that during early stages of cancer, the degree and incidence of elevation in serum PRL levels were much greater than those found for carcinoembryonic antigen (CEA), which is generally considered to be a circulating cervical tumor marker [120]. These studies suggested that PRL may be a potential marker for detecting early occult tumors and could be a guide for therapy of cervical carcinoma [121].Another documentation of ectopic PRL secretion came from a prospective study, including 46 female patients with a confirmed diagnosis of breast cancer, who were followed up for a total of 5 years, where serum concentrations of prolactin were measured before and after the therapy at regular intervals during the observation period. Their PRL concentrations were compared to those of 40 healthy women and 33 women with other types of cancer (mostly colorectal and lung cancers), who served as control groups.…”

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confidence: 99%

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Endocrine Paraneoplastic Syndromes: A Review

Arabi¹

2015

EMIJ

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It is important for the endocrinologist and oncologist to recognize these paraneoplastic endocrine syndromes since this may help in defining the cancer type and hence lead to the appropriate management. In addition, these syndromes are a major cause of morbidity and mortality. Moreover, AbstractParaneoplastic endocrine syndromes result from ectopic production of hormones by different tumors. Hypercalcemia of malignancy is the most common, mostly caused by ectopic parathyroid hormone related peptide (PTHrP) production which increases bone resorption. Other causes include the rare ectopic parathyroid hormone (PTH) production, ectopic production of 1, 25-(OH)2 vitamin D by the tumor and its adjacent macrophages and bone metastasis which by itself in addition to the local production of PTHrP at the level of the bone lead to bone resorption and thus hypercalcemia. Treatment includes extracellular fluid volume repletion, bisphosphonates or denosumab and calcitonin. Ectopic Cushing's syndrome caused by ectopic ACTH production results in hypokalemia, proximal muscle weakness, easy bruisability, hypertension, diabetes and psychiatric abnormalities including depression and mood disorders. Different diagnostic measures help to differentiate Cushing's disease from ectopic Cushing's syndrome. Treatment includes surgical resection of tumor and medical therapy to suppress excess cortisol production. Ectopic secretion of ADH has been associated with different tumor types. The best treatment options include removal of the underlying tumor, chemotherapy, or radiotherapy in addition to free water restriction, demeclocycline and vaptans. Ectopic growth hormone releasing hormone secretion has been identified with carcinoids, phechromocytoma and other tumors. Surgery is the mainstay of therapy with systemic therapy used in metastatic disease. Other rare ectopic hormone syndromes have also been identified including ectopic prolactin, ectopic erythropoietin, and thrombopoetin in addition to others. Keywords 2/12paraneoplastic endocrine syndromes may be the first presenting feature of malignancy [2,3]. This paper provides an overview on the common PNES, their prevalence, diagnosis, prognosis and response to treatment (Table 1). Methodology of Literature SearchEligible studies were identified by a search, from year 1920 up till February 2014, in Medline, PUBMED and EMBASE using a refined search strategy with several terms used including "endocrine paraneoplastic syndromes", "ectopic hormones", "humoral hypercalcemia of malignancy", "ectopic parathyroid hormone related peptide", "ectopic ACTH", "ectopic Cushing syndrome", "ectopic antidiuretic hormone", "syndrome of inappropriate ADH", "ectopic growth hormone releasing hormone", "ectopic growth hormone", "ectopic prolactin", "ectopic thyroid stimulating hormone" in addition to several others. In addition, searches of personal collections and the reference lists of eligible studies were identified with their full text papers being retrieved. A-Hypercalcemia of MalignancyHistorical Perspec...

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Ectopic prolactin secretion from a gonadoblastoma

Cited by 49 publications

References 38 publications

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Expression of functional prolactin and its receptor in human colorectal cancer

Endocrine Paraneoplastic Syndromes: A Review

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