Some aspects of metabolic changes in hyperprolactinemia of tumour and non-tumour genesis
Objective: To study some features of metabolic changes in the bone system and liver in a tumour and non-tumour genesis of hyperprolactinemia. Methods: 130 (90 women and 40 men, aged from 17 to 56 years) patients with tumour hyperprolactinemia (91 patients, 41 with macroadenoma and 50 with pituitary microadenoma) and non-tumour (39 patients) genesis were examined. The control group consisted of 30 people. The levels of hormones (prolactin, follicle-stimulating, luteinizing, thyrotropic, estradiol and testosterone), markers of bone metabolism (osteocalcin and C-terminal telopeptide), cholesterol, blood lipoproteins, transaminase, the concentration of vitamin D, as well as morphological studies of the liver. Results: A decrease in bone density according to densitometry and changes in calcium-phosphorus metabolism were detected in 47 (36.4%) patients (40 with pituitary adenoma and 7 without adenoma). Changes in the content of ionized Ca in serum were observed in 14 (29.9%) patients of the main group. A direct correlation was found between the level of prolactin and the C-terminal telopeptide (r=0.5284; p<0.05) and the inverse relationship between prolactin and osteocalcin (r=-0.4015; p<0.05). The degree of increase in the activity of ALAT and ASAT correlated with an increased level of prolactin (r=0.758; p<0.05). The correlation between the atherogenic coefficient and the level of prolactin revealed a positive pattern (r=0.822; p<0.05). Ultrasound revealed fatty hepatosis in 52 (40%) people, of whom 45 (34.6%) had different degrees of obesity. A study of liver biopsy specimens in 9 showed that in most cases (n=7) there was a minimal or moderate degree of fatty degeneration of hepatocytes. Conclusions: It has been established that in patients with hyperprolactinemia, especially with pituitary prolactinoma, there is a predisposition to the development of the osteopenic syndrome. Refinement of the study of bone tissue remodelling processes revealed the predominance of resorption processes over bone formation processes, which, as a result, leads to disruption of bone tissue microarchitectonics. The most common variant of dyslipidemia in the metabolic syndrome is the lipid triad: hypertriglyceridemia, a low level of high-density lipoproteins and an increase in the level of low-density lipoproteins.