Hyperprolactinaemia and Graves' disease

Prevalence of autoimmune disease in patients with prolactinomas and non-functioning pituitary adenomas

PURPOSE

Prolactin can affect autoimmune response and evidence suggests that hyperprolactinemia can primarily precipitate autoimmunity. We postulate that patients with prolactinomas are more prone to autoimmune disease (AID).

METHODS

We conducted a retrospective case-control study comparing prevalence of AID in 100 prolactinoma patients (PRL-P, cases) and 100 age- and gender-matched non-functioning pituitary adenoma patients (NFPA-P, controls) assessed at the Neuroendocrine Clinics of the McGill University Health Centre between January 2005 and December 2014. Comparisons were done using a conditional logistic regression (CLR) analysis. Multiple imputation was used to account for missing data values.

RESULTS

Sixty-eight women and 32 men were in each group. Median age was 37 years for PRL-P and 46 years for NFPA-P. AID was diagnosed in 28/100 cases and 16/100 controls. Autoimmune thyroid disease was the most common AID reported in both groups, representing 70 and 61% of the AID diagnoses respectively. CLR analysis revealed a multiplicative interaction effect between AID prevalence and age (p 0.004). Odds ratios for AID in PRL-P compared to NFPA-P increase with age and become significant at age 43, reaching 4.17 (95% CI 1.26, 13.82) at age 45 and 8.09 (95% CI 1.96, 33.43) at age 50 (p 0.05).

CONCLUSION

Our data showed a higher prevalence of AID in both PRL-P and NFPA-P than in a reference population. In both groups, prevalence of AID increased with age, given a multiplicative interaction effect. A significant higher prevalence of autoimmunity in PRL-P compared with NFPA-P occurs after age 43. These associations may have significant implications for the management of prolactinoma patients.