Гиперпролактинемия в период постменопаузы: версии и контраверсии
Гиперпролактинемия в период постменопаузы: версии и контраверсии
Лещенко О.Я. Гиперпролактинемия в период постменопаузы: версии и контраверсии. Терапевтический архив. 2021; 93 (10): 1234–1239. DOI: 10.26442/00403660.2021.10.201073
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Leshchenko OYa. Hyperprolactinemia in the postmenopause: versions and contraversions. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (10): 1234–1239. DOI: 10.26442/00403660.2021.10.201073
Гиперпролактинемия в период постменопаузы: версии и контраверсии
Лещенко О.Я. Гиперпролактинемия в период постменопаузы: версии и контраверсии. Терапевтический архив. 2021; 93 (10): 1234–1239. DOI: 10.26442/00403660.2021.10.201073
________________________________________________
Leshchenko OYa. Hyperprolactinemia in the postmenopause: versions and contraversions. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (10): 1234–1239. DOI: 10.26442/00403660.2021.10.201073
Распространенность гиперпролактинемии (ГПРЛ) у женщин в постменопаузе неизвестна и многими исследованиями оценивается как нечастая. Пролактиномы, обнаруженные после менопаузы, обычно являются макроаденомами и долгое время остаются нераспознанными из-за нетипичных клинических признаков или их отсутствия. Потенциал роста пролактином сохраняется после менопаузы, большинство из них инвазивны и сопровождаются высоким уровнем пролактина. Лечение агонистами дофамина обычно длительное, его целями являются уменьшение размеров опухоли, нормализация уровня пролактина, а соответственно, и негативных влияний ГПРЛ. Терапия каберголином позволяет достичь ремиссии заболевания в первые годы после отмены, однако через 5 лет после отмены препарата доля рецидивов увеличивается. В постменопаузе ремиссия пролактином неочевидна. Современный менеджмент пациентов с пролактиномой и/или ГПРЛ в период постменопаузы не имеет четких позиций. Дискуссионные вопросы: неоднозначная связь между уровнем пролактина и раком молочной железы, нет убедительных выводов по улучшению минеральной плотности костной ткани и/или снижению риска переломов при нормализации уровня пролактина, отсутствуют данные о метаболических параметрах после окончания лечения агонистами дофамина, противоречивы сведения, касающиеся уровней пролактина и выраженности многообразных проявлений климактерического синдрома. Применение эстроген-гестагенных препаратов у женщин с ГПРЛ/пролактиномами гипофиза также недостаточно изучено. Таким образом, проблема ГПРЛ в перименопаузальном и постменопаузальном периодах недооценена и нуждается в дополнительных исследованиях, как и разработка диагностических и терапевтических стратегий для потенциальной пользы в отношении потери веса, улучшения чувствительности к инсулину, снижения риска переломов, поддержания сексуальности и психоэмоционального благополучия.
Ключевые слова: гиперпролактинемия, пролактинома, постменопаузальный период, климакс
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The prevalence of hyperprolactinemia in postmenopausal women is unknown and has been estimated as infrequent by many studies. Prolactinomas found after menopause are usually macroadenomas and remain unrecognized for a long time due to atypical clinical signs or their absence. The growth potential of prolactinomas persists after menopause, most of them are invasive and accompanied by high prolactin levels. Treatment with dopamine agonists is usually long-term, the goals of which are to reduce tumor size, normalize prolactin levels and the negative effects of hyperprolactinemia. Treatment with cabergoline makes it possible to achieve remission of the disease in the first years after discontinuation, however, the proportion of relapses in postmenopausal women increases 5 years after discontinuation of the drug. Remission of prolactinomas is not evident in postmenopausal women. The modern management of patients with prolactinoma and/or hyperprolactinemia does not have clear positions in the postmenopausal period. Controversial issues remain: an ambiguous relationship between prolactin levels and breast cancer, there are no convincing conclusions on the improvement of bone mineral density and/or a decrease in the risk of fractures with normalization of prolactin levels, there are no data on metabolic parameters after the end of treatment with dopamine agonists, conflicting information about the relationship of prolactin levels and the severity of the manifold manifestations of the climacteric syndrome. The use of estrogen-progestin drugs in women with hyperprolactinemia/prolactinomas is also not well understood. Thus, the problem of hyperprolactinemia in the perimenopausal and postmenopausal period is underestimated and requires additional research, as well as the development of diagnostic and therapeutic strategies for potential benefits in terms of weight loss, improving insulin sensitivity, reducing the risk of fractures, maintaining sexuality and psycho-emotional well-being.
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1. Melnichenko GA, Dzeranova LK, Pigarova EA, et al. Federal clinical recommendations for clinic, diagnostics, differential diagnosis and methods for treatment of hyperprolactinemia. Problemy endokrinologii. 2013;59(6):19-26 (in Russian).
2. Melmed S, Casanueva F, Hoffman A. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:273-88. DOI:10.1210/jc.2010-1692
3. Casanueva F, Molitch M, Schlechte J. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol. 2006;65:265-73. DOI:10.1111/j.1365-2265.2006.02562.x
4. Melnichenko GA, Dzeranova LK, Pigarova EA, et al. The data of national medical interview on hyperprolactinemia treatment in real clinical practice. Ozhireniye i metabolizm. 2016;13(2):14-9 (in Russian). DOI:10.14341/omet2016214-19
5. Ji L, Yi N, Zhang Q, et al. Management of prolactinoma: a survey of endocrinologists in China. Endocr Connect. 2018;7(10):1013-9. DOI:10.1530/EC-18-0250
6. Beshyah S, Sherif I, Chentli F, et al. Management of prolactinomas: a survey of physicians from the Middle East and North Africa. Pituitary. 2017;20(2):231-40. DOI:10.1007/s11102-016-0767-5
7. Vilar L, Naves LA, Casulari LA, Azevedo MF. Management of prolactinomas in Brazil: an electronic survey. Pituitary. 2010;13(3):199-206. DOI:10.1007/s11102-010-0217-8
8. Tanner MJ, Hadlow NC, Wardrop R. Variation of female prolactin levels with menopausal status and phase of menstrual cycle. Obstet Gynaecol. 2011;51(4):321-4. DOI:10.1111/j.1479-828X.2011.01321.x
9. Pekić S, Medic Stojanoska M, Popovic V. Hyperprolactinemia/Prolactinomas in the Postmenopausal Period: Challenges in Diagnosis and Management. Neuroendocrinology. 2019;109:28-33. DOI:10.1159/000494725
10. Maiter D, Delgrange E. The challenges in managing giant prolactinomas. Eur J Endocrinol. 2014;170:R213-27.
11. Delgrange E, Raverot G, Bex M, et al. Giant prolactinomas in women. Eur J Endocrinol. 2013;170(1):31-8. DOI:10.1530/EJE-13-0503
12. Green A, Sherlock M, Stewart P, et al. Extensive experience in the management of macroprolactinomas. Clin Endocrinol (Oxf). 2014;81(1):85-92. DOI:10.1111/cen.12418
13. Mel'nichenko GA, Dzeranova LK, Barmina II, et al. Gender-specific features of hyperprolactinemia syndrome. Problemy endokrinologii. 2009;55(6):26-31 (in Russian). DOI:10.14341/probl200955626-31
14. Deepak D, Daousi C, Javadpour M, MacFarlane IA. Macroprolactinomas and epilepsy. Clin Endocrinol (Oxf). 2007;66(4):503-7. DOI:10.1111/j.1365-2265.2007.02759.x
15. Sarwar K, Huda M, Van de Velde V, et al. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 2013;98(6):2362-7. DOI:10.1210/jc.2013-1249
16. Shibli-Rahhal A, Schlechte J. The effects of hyperprolactinemia on bone and fat. Pituitary. 2009;12(2):96-104. DOI:10.1007/s11102-008-0097-3
17. Smetnik VP, Osipova AA. Hyperprolactinemia: bone response and the effectiveness of cabergoline therapy. Problemy reproduktsii. 2000;6:24-9 (in Russian).
18. Mazziotti G, Mancini T, Mormando M, et al. High prevalence of radiological vertebral fractures in women with prolactin-secreting pituitary adenomas. Pituitary. 2011;14(4):299-306. DOI:10.1007/s11102-011-0293-4
19. Seriwatanachai D, Krishnamra N, van Leeuwen JP. Evidence for direct effects of prolactin on human osteoblasts: inhibition of cell growth and mineralization. J Cell Biochem. 2009;107(4):677-85. DOI:10.1002/jcb.22161
20. Faje AT, Klibanski A. The treatment of hyperprolactinemia in postmenopausal women with prolactin-secreting microadenomas: cons. Endocrine. 2015;48(1):79-82. DOI:10.1007/s12020-014-0308-9
21. Dzeranova LK, Pigarova EA, Vasilyeva TO, et al. Hyperprolactinemia in a patient with advanced breast cancer: a clinical case. Opukholi zhenskoy reproduktivnoy sistemy. 2012;2:30-4 (in Russian).
22. Soto-Pedre E, Newey P, Bevan J, Leese G. Morbidity and mortality in patients with hyperprolactinaemia: the PROLEARS study. Endocr Connect. 2017;6(8):580-8. DOI:10.1530/EC-17-0171
23. Goffin V, Touraine P. The prolactin receptor as a therapeutic target in human diseases: browsing new potential indications. Expert Opin Ther Targets.2015;19(9):1229-44. DOI:10.1517/14728222.2015.1053209
24. Wang M, Wu X, Chai F, et al. Plasma prolactin and breast cancer risk: a meta- analysis. Sci Rep. 2016;6:25998. DOI:10.1038/srep25998
25. Medic Stojanoska M, Mitic G, Mitic I, et al. The influence of hyperprolactinemia on coagulation parameters in females with prolactinomas. Srp Arch Celok Lek. 2014;142:314-9.
26. Matsuda M, Mori T, Sassa S, et al. Chronic effect of hyperprolactinemia on blood glucose and lipid levels in mice. Life Sci. 1996;58:1171-7. DOI:10.1016/0024-3205(96)00075-6
27. Greenman Y, Tordjman K, Stern N. Increased body weight associated with prolactin secreting pituitary adenomas: weight loss with normalization of prolactin levels. Clin Endocrinol (Oxf). 1998;48(5):547-53. DOI:10.1046/j.1365-2265.1998.00403.x
28. Doknic M, Pekic S, Zarkovic M, et al. Dopaminergic tone and obesity: an insight from prolactinomas treated with bromocriptine. Eur J Endocrinol. 2002;147(1):77-84. DOI:10.1530/eje.0.1470077
29. Andersen M, Glintborg D. Metabolic syndrome in hyperprolactinemia. Front Horm Res. 2018;49:29-47. DOI:10.1159/000486000
30. Popovic V, Korbonits M. Metabolic Syndrome Consequent to Endocrine Disorders. Front Horm Res. 2018;49:29-47. DOI:10.1159/000486000
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Авторы
О.Я. Лещенко*
ФГБНУ «Научный центр проблем здоровья семьи и репродукции человека», Иркутск, Россия
*loyairk@mail.ru
________________________________________________
Olga Ya. Leshchenko*
Scientific Centre of Family Health and Human Reproduction Problems, Irkutsk, Russia
*loyairk@mail.ru