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Stumpf MAM, Galliano SA, Bueno CBF, Glezer A. Long-term use of clomiphene in male macroprolactinomas with persistent hypogonadism. Endocrine 2024; 85:152-157. [PMID: 38578401 DOI: 10.1007/s12020-024-03817-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Men with macroprolactinoma can present persistent hypogonadism despite normoprolactinemia achieved with clinical and/or neurosurgical treatment. Usually, testosterone replacement therapy is indicated. Nevertheless, although off-label, clomiphene citrate (CC), a selective estrogen receptor modulator, has also been used, mainly when fertility is an issue. The aim of this study is to evaluate the effectiveness of CC in recovering the gonadal axis in men with macroprolactinoma, with or without hyperprolactinemia, and evaluate its safety as a long-term therapy. METHODS This is a retrospective study including 10 men with macroprolactinoma on cabergoline treatment and persistent hypogonadism. All patients received initially 50 mg/d of CC. RESULTS The median age at diagnosis of prolactinomas was 34 (range, 26-60) years old. All patients were treated with cabergoline at a median maximum dose of 2 (1-7) mg/week, with a median time of treatment of 8.5 (2-15) years. Prolactin was still above the normal range when CC was introduced only in two patients. The mean duration of CC therapy was 3.2 (±2.8) years. Prolactin levels maintained stable (p = 0.252) and testosterone increased (p = 0.027) significantly on CC therapy. Tumor size remained stable. Eight patients (80%) maintained testosterone above 300 ng/dL and were classified as responders. Three responders succeeded in using a lower dose of CC and one of them completed withdrawal CC and maintained eugonadism. There were no side effects or safety concerns reported. CONCLUSION CC should be seen as a safe treatment option for men with macroprolactinoma and persistent hypogonadism.
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Affiliation(s)
- Matheo A M Stumpf
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, São Paulo, Brazil.
| | - Stefano A Galliano
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Cristina B F Bueno
- Serviço de Endocrinologia e Metabologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Andrea Glezer
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School Hospital, São Paulo, Brazil
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Gonzalez-Almazan JA, Cortes-Contreras AP, Flores-Rabasa R, Mendez-Garcia LA, Escobedo G, Navarro Olvera JL, Carrillo-Ruiz JD. Metabolic Syndrome Components in Patients with Pituitary Adenoma. Horm Metab Res 2024; 56:118-127. [PMID: 38081188 DOI: 10.1055/a-2209-0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Pituitary adenomas are benign tumors of the anterior portion of the pituitary gland (adenohypophysis), representing the 25% of all the tumor alterations. Pituitary adenomas are classified by the type of hormone secreted, cellularity, size, and structural alterations by the hormonal segregation. The diagnosis consists on the histopathological identification of cell types and the image-guided by magnetic resonance or tomography; the treatment can be both pharmacological and surgical. Metabolic Syndrome is the set of clinical conditions that increase the risk of cardiovascular diseases with an estimated prevalence of 25% worldwide. The alterations of metabolic syndrome are obesity, hypertension, dyslipidemia, insulin resistance, and diabetes mellitus type II. Pituitary adenomas and metabolic syndrome have an important relationship, hormone-secreting by pituitary adenomas affects a myriad of signaling pathways, which allows a favorable environment for the appearance of the metabolic syndrome. Moreover, patients with pituitary adenomas are shown to have an improvement in metabolic parameters after the medical/surgical treatment. The objective of this review is to explore the possible mechanisms through which PAs contributes to MetSx.
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Affiliation(s)
- Jorge A Gonzalez-Almazan
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico Facultad de Estudios Superiores Iztacala, Tlalnepantla, Mexico
| | - Ana Paula Cortes-Contreras
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Ciudad de Mexico, Mexico
| | - Regina Flores-Rabasa
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Faculty of Health Sciences, Anahuac University Mexico - Southern Campus, Ciudad de Mexico, Mexico
| | | | - Galileo Escobedo
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
| | - José L Navarro Olvera
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
| | - José D Carrillo-Ruiz
- Research Division, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Functional & Stereotactic Neurosurgery Unit, General Hospital of Mexico, Ciudad de Mexico, Mexico
- Coordination of Neuroscience, Faculty of Psychology, University Anahuac Mexico, Huixquilucan, Mexico
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Wang L, Wang X, Gong F, Pan H, Zhu H. Clinical characteristics of male prolactinoma patients mainly presenting with severe obesity and the metabolic response to dopamine agonist therapy. Front Endocrinol (Lausanne) 2023; 14:1285477. [PMID: 38093965 PMCID: PMC10716415 DOI: 10.3389/fendo.2023.1285477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Objective To summarize the clinical characteristics of 4 male prolactinoma patients with severe obesity. Methods The clinical data of all the patients were retrospectively analyzed. Results All the patients visited our hospital for severe obesity at the age of 16-30 years old with their body mass index (BMI) of 37.9-55.9 kg/m2. All the patients were obese since childhood, even at birth. Hyperprolactinemia (72.3-273.0 ng/ml) was found during the etiological screening of obesity and MRI revealed pituitary adenomas. Additionally, all of them had multiple obesity related complications, such as hyperinsulinemia and dyslipidemia. Treatment of dopamine agonists (DAs) effectively normalized their prolactin level and the pituitary MRI reexamination after 6 months of DAs treatment showed the shrinkage of the pituitary adenomas in 3 patients. Their weight also decreased in different degrees (2.70~19.03% lower than the baseline) with improved metabolic profiles. Conclusion Serum prolactin level should be screened in obese patients, especially those with severe obesity.
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Affiliation(s)
- Linjie Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojing Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Shanxi Yuncheng Central Hospital, Yuncheng, China
| | - Fengying Gong
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Pan
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huijuan Zhu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Kajero JA, Seedat S, Ohaeri JU, Akindele A, Aina O. Effects of cannabidiol on weight and fasting blood sugar with chronic and subchronic haloperidol administration. DISCOVER MENTAL HEALTH 2022; 2:18. [PMID: 37861864 PMCID: PMC10501030 DOI: 10.1007/s44192-022-00021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/05/2022] [Indexed: 10/21/2023]
Abstract
OBJECTIVES The duration of administration (e.g., subchronic or chronic) of haloperidol may influence its adverse effects. We studied the effects of duration of administration of haloperidol on body weight and fasting blood sugar (FBS). In addition, we examined whether orally administered cannabidiol (CBD) had any putative mitigating influence on haloperidol-induced body weight changes and FBS elevation. METHODS Haloperidol (5 mg/kg/day) was administered for 21 days (subchronic administration), via the intraperitoneal (IP) route, or monthly (50 mg/kg monthly) for 3 months (chronic administration), via the intramuscular (IM) route, either alone or before CBD (5 mg/kg/day). Oral CBD (5 mg/kg/day) alone and distilled water alone were administered for 21 days. Weight and FBS were measured before administration of pharmacological agents (distilled water in the control group) and post-administration. RESULTS Group differences in average weight across time were significant. Pairwise comparisons showed that mean weight of the subchronic (IP) haloperidol alone group (Group A) and the chronic (IM) haloperidol before CBD group (Group F) increased significantly over time. Post medications, there was a significant increase in mean FBS in the subchronic (IP) haloperidol group compared to the subchronic (IP) haloperidol before CBD group. There was also a significant reduction in mean FBS from the baseline for the control group only. CONCLUSION We demonstrated that the duration of administration of haloperidol influenced weight and FBS in rats, suggesting that metabolic side effects, may be influenced by duration of administration. CBD ameliorated the increase in weight and FBS observed in the subchronic (IP) haloperidol groups.
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Affiliation(s)
- Jaiyeola Abiola Kajero
- Federal Neuropsychiatric Hospital Yaba, 8, Harvey Road Yaba, P.M.B 2008, Lagos, Nigeria
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive Tygerberg, Cape Town, 7505 South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive Tygerberg, Cape Town, 7505 South Africa
| | - Jude U. Ohaeri
- Department of Psychological Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State Nigeria
| | - Abidemi Akindele
- Department of Pharmacology, Therapeutics & Toxicology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Private Mail Bag 12003, Lagos, Nigeria
| | - Oluwagbemiga Aina
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research (NIMR), 6, Edmund crescent off Murtala Mohammed way, Yaba, P.M.B. 2013, Lagos, 100001 Nigeria
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Insights into the perspective correlation between vitamin D and regulation of hormones: sex hormones and prolactin. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2021. [DOI: 10.2478/cipms-2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Aim. Vitamin D is currently an exciting research target, besides its obvious role in calcium homeostasis and bone health, enormous work is being directed at examining the effects of this vitamin on various biological functions and pathological conditions.
Material and methods. The review of the literature and the analysis took about six months and was carried out through PubMed. This is a search engine opening mainly the MEDLINE database of trusted references. We called up all studies written in English that were published between the years 2004 to 2021 and that came through using the applied search terms, and analysed all those that met the criteria.
Results. The endocrine system with its many glands and hormones and their essential roles in the maintenance of normal body functioning cannot be far from interactions with vitamin D. Male and female sex hormones are no exceptions and many studies have investigated the correlations between these hormones and vitamin D. As such, direct and indirect relationships have been found between vitamin D, its receptors or one of its metabolising enzymes with sex hormones and the development of reproductive organs in males and females.
Conclusion. This review summarises the research investigating the associations of vitamin D with sex hormones and reproductive organs in males and females, and thus may pave the road for future studies that will investigate the clinical significance of vitamin D in the management of reproductive system disorders. Despite some conflicting results about the relationship between VD and the effectiveness of the reproductive system, many studies confirm the presence of receptors for this vitamin in the reproductive system, and this supports the direct or indirect relationship between VD and prolactin or VD and testosterone through PO4 and Ca2+ homeostasis, or production of osteocalcin. Therefore, VD is positively associated with semen quality and androgen status. Furthermore, a direct relationship between VD and the production of progesterone, estrogen and estrone in human ovarian cells has been supported by many studies.
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