madman
Super Moderator
8. Five-year view
Prolactin is a metabolic hormone, besides the well-known actions on fertility and reproduction. Dopaminergic tone plays a key role in the regulation of the metabolic system by modulating PRL secretion. Treatment of PRL excess with the dopamine-agonists bromocriptine and cabergoline has demonstrated to produce beneficial effects on gluco-insulinemic and lipid metabolism in obese diabetic patients, regardless of concomitant hyperprolactinemia, also providing promising results about their potential use as alternative or adjunctive treatment for type 2 diabetes mellitus. Future studies will better elucidate the burden and the differential role of PRL and dopamine-agonists on the modulation of metabolism in patients with hyperprolactinemia.
Key issues
● PRL is a metabolic hormone.
● PRL excess induces hyperphagia and obesity, and promotes abnormalities in gluco-insulinemic and lipid profile, leading to metabolic syndrome in approximately one third of patients with hyperprolactinemia
● Medical treatment of hyperprolactinemia with dopamineagonists bromocriptine and cabergoline induces weight loss and improves lipid profile by reducing total and LDLcholesterol and triglycerides, and increasing HDL-cholesterol.
● Fasting glucose and insulin levels reduce while on dopamine-agonists, together with a significant amelioration in insulin resistance and peripheral insulin sensitivity.
● Prevalence of metabolic syndrome significantly reduces after treatment with dopamine-agonists in patients with hyperprolactinemia.
● The metabolic improvement seen after treatment is independent on the degree of reduction in PRL levels, and should be ascribed to dopamine-agonists dosage, mainly in patients receiving cabergoline.
● In male patients with concomitant hypogonadism, proper androgen replacement is mandatory to effectively ameliorate insulin resistance and metabolic syndrome.
Prolactin is a metabolic hormone, besides the well-known actions on fertility and reproduction. Dopaminergic tone plays a key role in the regulation of the metabolic system by modulating PRL secretion. Treatment of PRL excess with the dopamine-agonists bromocriptine and cabergoline has demonstrated to produce beneficial effects on gluco-insulinemic and lipid metabolism in obese diabetic patients, regardless of concomitant hyperprolactinemia, also providing promising results about their potential use as alternative or adjunctive treatment for type 2 diabetes mellitus. Future studies will better elucidate the burden and the differential role of PRL and dopamine-agonists on the modulation of metabolism in patients with hyperprolactinemia.
Key issues
● PRL is a metabolic hormone.
● PRL excess induces hyperphagia and obesity, and promotes abnormalities in gluco-insulinemic and lipid profile, leading to metabolic syndrome in approximately one third of patients with hyperprolactinemia
● Medical treatment of hyperprolactinemia with dopamineagonists bromocriptine and cabergoline induces weight loss and improves lipid profile by reducing total and LDLcholesterol and triglycerides, and increasing HDL-cholesterol.
● Fasting glucose and insulin levels reduce while on dopamine-agonists, together with a significant amelioration in insulin resistance and peripheral insulin sensitivity.
● Prevalence of metabolic syndrome significantly reduces after treatment with dopamine-agonists in patients with hyperprolactinemia.
● The metabolic improvement seen after treatment is independent on the degree of reduction in PRL levels, and should be ascribed to dopamine-agonists dosage, mainly in patients receiving cabergoline.
● In male patients with concomitant hypogonadism, proper androgen replacement is mandatory to effectively ameliorate insulin resistance and metabolic syndrome.
