The effects of hyperprolactinemia and its control on metabolic diseases

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.
 

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