Hyperostosis frontalis interna, acromegaly and hyperprolactinaemia

Abstract

Summary:The association between hyperostosis frontalis interna (HFI), acromegaly and hyperprolactinaemia was investigated. Thirty six acromegalic patients, of whom 19 had hyperprolactinaemia, were compared with 36 randomly-selected, age-sex matched controls. There was a higher prevalence of HFI in the skull X-rays of the acromegalic cohort (P = 0.0002) when compared to the control group. This difference was apparent in both men (P = 0.01) and women (P = 0.01). Acromegalic patients with hyperprolactinaemia also expressed HFI in a higher proportion of individuals than the control group (P = 0.0001). Intra-and interobserver variability was assessed and concordance with 100% and 97% in the moderate and severe HFI sub-groups. The following sub-group analysis was undertaken: acromegalics and those acromegalics with hyperprolactinaemia were compared with the controls and a highly significant distinction was confirmed (P = 0.0007 and P = 0.00001 respectively). A relationship between HFI severity and the patient's age was noted in both male and female acromegalics. Also, the severity of HFI appeared related to disease duration in female acromegalics.The cause of HFI remains unknown but appears to be strongly associated with acromegaly, particularly in the presence of co-existent hyperprolactinaemia. The association may have symptomatic significance and the presence of HFI should be confirmed or refuted in all patients with acromegaly.

Hyperostosis frontalis interna in female historic skeletal populations: Age, sex hormones and the impact of industrialization

“…This was the case up to the 50–59 year old age group. Following that, HFI rates appear to remain relatively consistent, as is similarly reported in other research (Fulton, Shand, Ritchie, & McGhee, ; Herschkovitz et al, ; May, Peled, Dar, Cohen, et al, 2011; Nikolić et al, ; Win & Aparici, ). The results of this study, therefore, support the findings of an age‐related increase in HFI reported in the general literature but also confirm a plateau in post‐menopausal age‐related manifestation of HFI in the 50+ year age groups.…”

“…Increases of 72% free testosterone, 17% testosterone 16% androstenedione were all reported in obese females as well as increases of 47% estradiol, 89% free estradiol and 47% estrone (Key et al, ). HFI has also been associated with significant increases of androgen levels, including free testosterone (Fulton et al, ) as well as serum DHEA, DHEA‐S and total testosterone in past studies of pre‐menopausal females without signs of virilism (Kollin & Fehér, ). Androgenicity is highly dependent on FT and the associated lower levels of SHGB (Abdel‐Rahman & Hurd, ).…”

Frontal cortex dysfunction due to extensive hyperostosis frontalis interna

“…Sexual hormones for example, oestrogen stimulation,1–could play a part in the emergence of HFI and explain its predominance among female. Other metabolic disorders or endocrinopathies have been highlighted, such as acromegaly (especially when associated with hyperprolactinemia),10 11 diabetes or leptin hyper secretion 8 12. Genetic predisposing factors are also involved 6 13…”

A case of extensive hyperostosis frontalis interna in an 87‐year‐old female human cadaver

“…Pawlikowski and Komorowski (1987) stated that 43.2% of women with hyperprolactinemia-induced galactorrhea had concurrent HFI. Fulton et al (1990) correlated acromegaly with increased occurrence of HFI and hyperprolactinemia. Mulhern et al (2006) suggest that genetic factors and environmental factors such as dietary phytoestrogens may explain the high incidence of HFI in the Anasazi at Pueblo Bonito.…”