Available online 22 February 2024, 101479

Author links open overlay panel, , , , , , , ABSTRACTObjective

Hyperprolactinemia has negative impacts on metabolism and musculoskeletal health. In this study, individuals with active prolactinoma were evaluated for nonalcoholic fatty liver disease (NAFLD) and musculoskeletal health, which are underemphasized in the literature.

Methods

Twelve active prolactinoma patients and twelve healthy controls matched by age, gender, and BMI were included. Magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was used to evaluate hepatic steatosis and magnetic resonance elastography (MRE) to evaluate liver stiffness measurement (LSM). Abdominal muscle mass, and vertebral MRI-PDFF was also evaluated with MRI. Body compositions were evaluated by dual energy X-ray absorptiometry (DXA). The skeletal muscle quality (SMQ) was classified as normal, low and weak by using “handgrip strength/appendicular skeletal muscle mass (HGS/ASM)” ratio based on the cut-off values previously stated in the literature.

Results

Prolactin, HbA1c and CRP levels were higher in prolactinoma patients (p<0.001, p=0.033 and p=0.035, respectively). The median MRI-PDFF and MRE-LSM were 3.0% (2.01-15.20) and 2.22 kPa (2.0-2.5) in the prolactinoma group and 2.5% (1.65-10.00) and 2.19 kPa (1.92-2.54) in the control group, respectively and similiar between groups. In prolactinoma patients, liver MRI-PDFF showed a positive and strong correlation with the duration of disease and traditional risk factors for NAFLD. Total, vertebral and pelvic bone mineral density was similar between groups, while vertebral MRI-PDFF tended to be higher in prolactinoma patients (p=0.075). Muscle mass and strength parameters were similar between groups, but HGS/ASM tended to be higher in prolactinoma patients (p=0.057). Muscle mass was low in 33.3% of prolactinoma patients and 66.6 of controls. According to SMQ, all prolactinoma patients had normal SMQ, whereas 66.6% of the controls had normal SMQ.

Conclusion

Prolactinoma patients demonstrated similar liver MRI-PDFF and MRE-LSM to controls despite their impaired metabolic profile and lower gonadal hormone levels. Hyperprolactinemia may improve muscle quality in prolactinoma patients despite hypogonadism.

Section snippetsINTRODUCTION

Prolactinomas are the most prevalent pituitary secretory adenomas, accounting for roughly 40% of all pituitary adenomas1. Although most prolactinoma symptoms and signs are related to mass effect or hypogonadism, reduced bone density, weight gain, impaired lipid and metabolic profile can also be observed in patients2,3.

Prolactin modulates mediators in glucose and lipid metabolism, increases insulin release and inhibits fat storage4. Although these effects are considered to enhance the risk of

Participants

Twelve active prolactinoma and twelve healthy control included. Treatment-naive patients or patients whose prolactin level remained >25 μg/L despite treatment were considered active prolactinoma7. Individuals younger than 18 and older than 65 years, pregnant and lactating women, those with chronic alcohol use, viral hepatitis or liver disease with a clear etiology, active cancer patients, those with chronic kidney failure, heart failure, history of rheumatological disease, history of

Characteristics of Prolactinoma Patients

Of the twelve prolactinoma patients, 66.6% were female, 33.3% were male. While the median age of prolactinoma patients was 34.3 (28.9-41.6) years, the median age at diagnosis was 30.5 years (26.5-37.5). The median duration of disease was 2.65 years (0.6-5.15), and the median prolactin level at diagnosis was 154.4 μg/L (110.7-4682.7). At the time of diagnosis, seven (58.3%) patients had microadenoma and five (41.6%) had macroadenoma. Transsphenoidal surgery was performed on five (41.6%) of the

DISCUSSION

In this study, we studied for the first time the association between NAFLD, hepatic fibrosis, and osteosarcopenia in patients with active prolactinoma compared to healthy controls. We did not see an increase in NAFLD and liver fibrosis in prolactinoma patients. Patients with prolactinoma tended to have a higher vertebral MRI-PDFF and skeletal muscle quality.

Prolactinoma is characterized by an elevated prolactin level due to a lactotropic adenoma and complications related to hyperprolactinemia17

Conclusion

Liver MRI-PDFF and MRE-LSM in prolactinoma patients were similar to healthy controls despite relatively impaired metabolic profile and lower gonadal hormone levels. Due to high correlation between liver fat rate and well-defined NAFLD risk variables, it seems acceptable to examine prolactinoma patients for NAFLD risk in the same manner as patients in general population. Vertebral MRI-PDFF tends to be higher in prolactinoma patients than in controls. High vertebral MRI-PDFF may be a result of

Conflicts of interest

The authors declare no potential conflicts of interest.

Funding

This work was supported by Hacettepe University Scientific Research Projects Coordination Unit (Project number TTU-2021-19463).

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© 2024 The International Society for Clinical Densitometry. Published by Elsevier Inc.