Lack of Adrenal Androgen Stimulation by ACTH in Extreme Hyperprolactinemia

Abstract

Acute and prolonged oil -24 corticotropin stimulation was performed on a treated chromophobe adenoma patient with partial ACTH deficiency and extreme hyperprolactinemia. Cortisol and aldosterone stimulated normally. However, the basal concentrations of androstenedione (A) and dehydroepiandrosterone (DHA) were low, and that of DHA-sulfate (DHAS) was undetectable. Furthermore, A and DHA did not stimulate normally, and DHAS did not stimulate at all. It has been claimed that adrenal androgen production is increased in hyperprolactinemia. However, the inability of prolactin (Prl) to maintain adrenal androgen (AA) secretion, with and without added ACTH, is demonstrated in this patient.

Effects of drugs associated with hyperprolactinemia on plasma steroids and on steroid receptors and metabolism in human breast cancer

“…In the present study, ingestion of these drugs did not influence the levels of steroid hormones irrespective of the effect on plasma prolactin. This is contrary to the report of Vermeulen and Ando (15), who observed raised levels of adrenal androgens in hyperprolactinemic patients, but is in agreement with the findings of others (29,30). Our observation that these drugs also did not influence the levels of steroid receptors within the tumor or the ability of the tumor to metabolize steroids, even when hyperprolactinemia was induced, is in contrast to the results of our studies on rat DMBA-induced mammary tumors (13).…”

Control of Adrenal Androgen Secretion*

“…In one study, concentrations of A and DHA were also found to be unchanged from normal (144). A man with a chromophobe adenoma, PRL levels greater than 2,000 ng/ml, and a brisk cortisol and aldosterone response to cosyntropin has been reported (147) to have low A and DHA levels, which were subnormally responsive to cosyntropin. In addition, DHAS was undetectable, both before and after cosyntropin.…”

Female Hirsutism: Pathophysiological Considerations and Therapeutic Implications*

“…Prolactin (PRL) has attracted attention since some workers found elevated plasma and urinary levels of DHAS in patients with hyperprolactinemia (15,16). Unfortunately, these findings have not been adequately confirmed (17,18) and PRL does not seem to be a physiologic regulator of adrenal androgen secretion (19). Rather, recent reports are consistent with an increase in free testosterone (T) concentration in hyperprolactinemia due to a decrease in sex hormone binding globulin (SHBG) (20) which is reversible after bromocryptine therapy (21).…”