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Functional Hyperprolactinemia and Hypophyseal Microadenoma in Systemic Sclerosis
OLGA VERA-LASTRA, LUIS J. JARA, GABRIELA MEDINA, JUAN L. ROJAS, FRANCISCO VELÁSQUEZ, RAUL ARIZA, ASUNCIÓN NORMANDÍA, and MARGARITA FUENTES ABSTRACT. Objective. Hyperprolactinemia (HPRL) has been identified in more than half of patients with systemic sclerosis (SSc). However, the association with pituitary adenoma and the status of hypothalamic dopaminergic tone using metoclopramide (MTC) test has not been studied. We investigated the prevalence of prolactin (PRL)-secreting pituitary adenoma and evaluated production of PRL by dynamic testing with MTC in SSc. Methods. We studied 30 patients with SSc (mean age 38 ± 10 yrs) and 20 healthy controls (mean age 37 ± 11 yrs). Serum PRL concentrations were determined by radioimmunoassay in all subjects, and PRL response was measured 30, 60, 90, and 120 min after injection of 10 mg of MTC. Computed tomography (CT) of the sella turcica was performed. Results. The mean basal serum PRL levels before and after stimulation with MTC in SSc patients versus controls were: basal 18.2 ± 5.4 versus 8.7 ± 1.6 ng/ml, p = NS; 30 min: 175.0 ± 5.4 versus 61.0 ± 42 ng/ml, p < 0.001; 60 min: 160 ± 64 versus 52 ± 30 ng/ml, p < 0.001; 90 min: 125 ± 57 versus 42 ± 21.0 ng/ml, p < 0.05; 120 min: 108.0 ± 57 versus 30.0 ± 10 ng/ml, p < 0.005. CT scan showed microadenomas in 24/30 SSc patients and 1/20 controls (p = 0.001). Conclusion. Our study suggests that a group of patients with SSc have a high prevalence of HPRL with increased central dopaminergic tone, and microadenomas. PRL may have a role in the pathogenesis of SSc. Further studies are necessary to confirm our results. (First Release May 15 2006; J Rheumatol 2006;33:1108–12) Key Indexing Terms:
SYSTEMIC SCLEROSIS
From the Department of Internal Medicine, Division of Research, Clinical and Epidemiology Research Unit, Department of Endocrinology, Office of Education and Research, and Departments of Nuclear Medicine and Radiology, Hospital de Especialidades, Centro Medico La Raza, IMSS; and Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico. O. Vera-Lastra, MD, Department of Internal Medicine, IMMS and UNAM; L.J. Jara, MD, Division of Research, IMMS and UNAM; G. Medina, MD, Clinical and Epidemiology Research Unit, IMMS; J.L. Rojas, MD, Department of Internal Medicine, IMMS; F. Velásquez, MD, Department of Endrocrinology, IMMS; R. Ariza, MD, Office of Education and Research, IMMS and UNAM; A. Normandía, MD, Department of Nuclear Medicine, IMMS; M. Fuentes, MD, Department of Radiology, IMMS. Address reprint requests to Dr. L.J. Jara, Research Division, Hospital de Especialidades, Seris/Zaachila S/N, Colonia La Raza, Mexico City 02990, Mexico. E-mail: luis_jara_quezada@hotmail.com Accepted for publication January 30, 2006.
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