Progressive trabecular osteopenia in women with hyperprolactinemic amenorrhea.

Abstract

Reductions in cortical and trabecular bone mass have been documented in young women with hyperprolactinemic amenorrhea. It is unknown whether trabecular osteopenia is progressive or reversible with treatment of hyperprolactinemia. In addition, it is not known whether clinical or hormonal variables can predict trabecular bone density (BD) changes. Therefore, we investigated prospectively trabecular BD by computed tomography in 52 hyperprolactinemic women and 41 controls. The mean follow-up interval was 1.8 +/- 0.1 (SEM) yr. Patient groups were defined as follows: group 1, amenorrhea during the entire study; group 2, restoration of menses during the study by treatment of hyperprolactinemia; group 3, regular menses despite hyperprolactinemia, with no history of prior amenorrhea; group 4, history of prior amenorrhea, but menses restored with treatment of hyperprolactinemia before study entry; and group 5, oligomenorrhea. Groups 1, 2, and 4 had significant (P = 0.0006) initial spinal osteopenia [mean BD 141 +/- 7 (SEM), 144 +/- 9, and 151 +/- 5 mg/cc K2HPO4, respectively] compared with controls or with group 3 (170 +/- 4 and 173 +/- 8 mg/cc K2HPO4, respectively). Group 5 had an initial mean BD which was midway between that of the amenorrheic and eumenorrheic women (156 +/- 13 mg/cc K2HPO4). Group 1 had a significant (P = 0.04) decrease in mean BD to 132 +/- 8 mg/cc K2HPO4 over 1.7 +/- 0.2 yr, with BD in 42% of the group more than 2 SD below the control mean at the final study point. The mean BD in group 2 increased to 155 +/- 9 mg/cc K2HPO4, approaching significance (P = 0.07) when compared with the initial BD. Five of the nine patients in this group (56%) had an increase in BD greater than the variation expected for the computed tomography technique. However, 44% of the group 2 patients had a spinal BD which remained more than 1 SD below the normal mean. There was no change in BD in the other groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Osteopenia as a feature of the androgen insensitivity syndrome

“…This suggestion accords with evidence for a role of androgens in the maintenance of male and female skeletal integrity. A prospective study by Biller et al (1992) of 52 hyperprolactinaemic women, both with and without amenorrhoea, revealed that both serum free testosterone and DHEAS concentrations correlated positively with the slope of bone density over time (P = 0.001 and 0.03 respectively) (Biller et al, 1992). Hypogonadal males, irrespective of aetiology, exhibit accelerated bone loss which is correctable by testosterone replacement therapy (Greenspan et al, 1986;Stepan et al, 1989;Jackson et al, 1987).…”

Higher doses of cabergoline further improve metabolic parameters in patients with prolactinoma regardless of the degree of reduction in prolactin levels

“…In all patients, MRI revealed the presence of a pituitary tumour. Tumour volume was calculated in line with the Di Chiro and Nelson formula (volume = height 9 length 9 width 9 p/6) and was expressed as mm 3 . BMI and systolic (SBP) and diastolic (DBP) blood pressure were measured in all patients.…”

“…1 Besides the well-known consequences on the reproductive axis both in men and women, hyperprolactinaemia can be associated with alterations in body composition and obesity, 2 although the evidence is discordant. Reduced bone density 3,4 and total body fat 5,6 have been positively associated with high prolactin (PRL) levels in patients with prolactinoma. Schmid et al 7 demonstrated significantly higher body mass index (BMI) in patients with macroprolactinoma than both patients with inactive adenomas and the general population.…”

Severe impairment of bone mass and turnover in Cushing’s disease: comparison between childhood‐onset and adulthood‐onset disease

“…Since the accumulation of bone mass during childhood is critical for the attainment of peak bone mass, a major determinant of osteoporosis (Matkovic, 1996), this might imply that the age of onset of hypercortisolism has different effects on bone density. In this regard, it has been shown that young hyperprolactinaemic males have more severe bone impairment than patients developing hyperprolactinaemia at an older age (Greenspan et al , 1986;Biller et al , 1992;Di Somma et al , 1998a,b). Similarly, patients with childhood-onset (co) GH deficiency have a greater reduction of bone mass than patients with adulthood-onset (ao) disease (Kaufmann et al , 1992;De Boer et al , 1994).…”