Elevated Prolactin Levels Research Articles

Uncovering ovarian reserve: Insights into hormones, lipids, and essential metals

: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age group. The intricate nature of PCOS development is highlighted by fluctuations in various sex hormones, such as luteinizing hormone(LH), follicle-stimulating hormone and prolactin. This study aims to assess the lipid profile levels, vital metals and sex hormones in the serum of patients with PCOS and contrast these findings with normal controls.The study analyzed health metrics between 57 women with PCOS and 57 normal controls. The lipid profile was assessed using Beckman Coulter AU480. Sex hormones were estimated using Roche Diagnostics Cobas 6000. Inductively coupled plasma mass spectrometry (ICPMS) was used to measure the essential trace metals, including magnesium (Mg), copper (Cu) Selenium (Se) and zinc (Zn).: The PCOS patients exhibited significantly elevated levels of LH (9.52 vs 3.48, p<0.0001), FSH (9.91 vs. 6.12, p<0.0001) and prolactin (24.71 vs. 16.41, p=0.03) mIU/ml. The correlation study showed a significant positive correlation between AMH and Se levels (R=0.27, p=0.045) and between LH and HDL (R=0.76, p=0.030).: In patients with PCOS, LH, FSH, and prolactin levels were found to be increased. A correlation was observed between Se and AMH, and a relationship was noted between LH and HDL. Selenium appears to have a significant influence on the ovarian reserve.

Effect of baseline prolactin levels on the pregnancy outcomes after fresh embryo transfer.

There is clinical disagreement on whether to treat hyperprolactinemia with medication before embryo transfer. The aim of this study is to identify the impact of basal prolactin (PRL) levels on pregnancy outcomes in fresh embryo transfer cycles. This retrospective study involved 2,648 women who underwent basal PRL level testing and fresh embryo transfer between January 2015 and December 2020 at our Hospital's Department of Assisted Reproduction. Basal PRL levels can be classified into three categories:<30 (n=2339), 30‑60 (n=255), and ≥60 (n=54) µg/l. Pregnancy outcome was defined as the primary outcome measure, and the live birth rate was defined as the second outcome measure. Subsequently, univariate and multivariable logistic regression analysis was used to reveal the association between basal PRL levels and pregnancy outcomes after considering several potential confounding factors. Elevated basal PRL levels were found not a risk factor for pregnancy outcomes in patients receiving good-quality embryo transfer (p>.05). For pregnancy or not, female age (OR: 1.03; 95% CI: 1.01-1.05), embryos transferred (OR: 0.52; 95% CI: 0.41-0.65), and normal fertilization rate (OR: 0.68; 95% CI: 0.48-0.97) were found to be an independent risk factor. For ongoing pregnancy or not, female age (OR: 1.07; 95% CI: 1.03-1.11), embryos transferred (OR: 0.57; 95% CI: 0.37-0.88), and menstrual cycle (OR: 1.76; 95% CI: 1.22-2.54) were also independent risk factors. There is no adverse impact on pregnancy outcomes during embryo transfer cycles with good-quality embryos when PRL levels are elevated.

Metabolic and inflammatory parameters in relation to baseline characterization and treatment outcome in patients with prolactinoma: insights from a retrospective cohort study at a single tertiary center.

Prolactinomas (PRLs) are prevalent pituitary adenomas associated with metabolic changes and increased cardiovascular morbidity. This study examined clinical, endocrine, metabolic, and inflammatory profiles in PRL patients, aiming to identify potential prognostic markers. The study comprised data from 59 PRL patients gathered in a registry at the University Hospital of Zurich. Diagnostic criteria included MRI findings and elevated serum prolactin levels. We assessed baseline and follow-up clinical demographics, metabolic markers, serum inflammation-based scores, and endocrine parameters. Treatment outcomes were evaluated based on prolactin normalization, tumor shrinkage, and cabergoline dosage. The PRL cohort exhibited a higher prevalence of overweight/obesity, prediabetes/diabetes mellitus, and dyslipidemia compared to the general population. Significant correlations were found between PRL characteristics and BMI, HbA1c, and fT4 levels. Follow-up data indicated decreases in tumor size, tumor volume, prolactin levels, and LDL-cholesterol, alongside increases in fT4 and sex hormones levels. No significant associations were observed between baseline parameters and tumor shrinkage at follow-up. A positive association was noted between PRL size/volume and the time to achieve prolactin normalization, and a negative association with baseline fT4 levels. This study underscores the metabolic significance of PRL, with notable correlations between PRL parameters and metabolic indices. However, inflammatory markers were not significantly correlated with patient stratification or outcome prediction. These findings highlight the necessity for standardized follow-up protocols and further research into the metabolic pathogenesis in PRL patients.

Male gynecomastia linked to antipsychotics: a case report

IntroductionGynecomastia refers to the abnormal development of breast tissue in males, often posing a concerning symptom. Often, gynecomastia is associated with multiple factors, including the use of various drugs, notably certain atypical antipsychotics. Gynecomastia is a significant side effect that affects the quality of life of male patients taking antipsychotic medications. Among these, risperidone and paliperidone have been identified as the most prone to causing gynecomastia, although aripiprazole has garnered attention for its superior profile in controlling prolactin and gynecomastia. The relationship between these drugs and the development of gynecomastia lies in their ability to elevate prolactin levels, a hormone that regulates reproductive function and is involved in milk production. Several studies have shown that prolactin levels are more commonly elevated with risperidone and paliperidone prescription, thus triggering gynecomastia.ObjectivesThe study aims to investigate the management of gynecomastia in male patients receiving antipsychotic medications.MethodsThis research employs a retrospective analysis of patient records to examine the association between specific antipsychotic drugs, prolactin levels, and the development of gynecomastia, while also evaluating the effectiveness of aripiprazole as an alternative treatment.ResultsWe present the case of a 21-year-old male with no prior medical history who initiated treatment with oral paliperidone and later switched to 100 mg of long-acting injectable paliperidone once monthly during his initial admission for psychotic symptoms. After six months, he developed gynecomastia, which was ruled out as breast tissue and was determined to be an increase in adipose tissue. Since his hospital discharge, he has gained 25 kg (30%) in body weight, and his baseline prolactin level has decreased. This weight gain, a common side effect of several antipsychotics, was linked to gynecomastia. However, a promising approach for gynecomastia antipsychotic-associated treatment is aripiprazole, which has a milder impact on prolactin levels. In this case, during the next appointment, a switch to 400 mg of long-acting injectable aripiprazole once-monthly was made, which led to weight loss, a reduction in breast size and blood prolactin levels in the following weeks.ConclusionsThe detection and management of gynecomastia in these patients are crucial to improving their quality of life and treatment adherence. This management encompasses changes in medication, hormonal therapy, or surgery in severe cases. Physicians must be aware of this potential complication when prescribing antipsychotics and closely monitor at-risk patients. In summary, antipsychotic-associated gynecomastia in men represents a medical challenge that requires careful attention and an individualized treatment strategy for each affected patient.Disclosure of InterestNone Declared

Parameters of PCOS in Tertiary Hospital in Bangladesh

Background: Polycystic ovarian syndrome (PCOS) represents a complex endocrinopathy with significant metabolic implications. The Rotterdam criteria establish the diagnosis based on the presence of two of three criteria: ultrasound-confirmed polycystic ovaries, hyperandrogenism, and persistent anovulation. Objective: Our objective was to investigate hormonal and anthropometric parameters in PCOS patients compared to controls, aiming to elucidate predictive markers and metabolic aberrations. Method: A case-control study comprising 50 PCOS subjects and 50 controls was conducted, focusing on females aged 18-40 attending an obstetrics and gynecology department, Tertiary hospital. Hormonal assays and anthropometric measurements were performed following strict inclusion and exclusion criteria. Results: Significant differences emerged between PCOS and control groups across various parameters. PCOS individuals displayed elevated levels of TSH, LH, FSH, and prolactin, coupled with increased BMI and altered waist-to-hip ratio, indicating early metabolic disruptions. Notably, the LH:FSH ratio was lower in PCOS subjects, suggesting hormonal imbalances. Conclusion: High levels of thyroid-stimulating hormone, LH, FSH, and prolactin, coupled with elevated body mass index and waist-to-hip ratio, served as indicators of PCOS and early metabolic irregularities.

Twisted Ovarian Cyst, Galactorrhea and Pituitary Hyperplasia Misdiagnosed as Prolactinoma: An Overlooked Longstanding Overt Hypothyroidism from Hashimoto’s Thyroiditis

We describe a 14-year-old girl who was referred for management of a prolactin-secreting pituitary adenoma as she had persistent milky discharge from her nipples, an elevated prolactin level and pituitary enlargement. Upon reviewing the medical history, it was noted that she had a history of secondary amenorrhea for 1 year, and had undergone an oophorectomy for twisted left ovarian cyst 5 months earlier. The physical examination found that she had a goiter, short stature and was relatively overweight. Based on these findings, it was thought that the patient likely had longstanding overt hypothyroidism. A thyroid function test (TFT) revealed a free thyroxine (FT4) level of 0.2 ng/dL and thyroid stimulating hormone (TSH) &gt;100 mU/L, with high levels of antithyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies, leading to the diagnosis of Hashimoto’s thyroiditis. After 8 months of levothyroxine treatment, the galactorrhea had disappeared, the pituitary enlargement had resolved and her menstruation had resumed normally, along with a 4-kg weight loss and 3-cm height gain. In summary, when evaluating a girl with ovarian cyst(s), especially if accompanied by other clinical findings like goiter, short stature, or menstrual irregularities, the physician should include hypothyroidism in the differential diagnosis. Early diagnosis and treatment of hypothyroidism can have a positive impact on the overall health and well-being of these patients, potentially preventing further complications related to both the thyroid disorder and ovarian cyst(s).

Endoscopic Endonasal Transcavernous Hemipituitary Transposition for Resection of Invasive Prolactinoma: 2-Dimensional Operative Video.

Invasive prolactinomas often require multimodal management including medical and surgical interventions. Here, we present the case of a 34-year-old man with a history of progressive visual disturbances. MRI unveiled a sella lesion with suprasellar and retrosellar extensions. Elevated prolactin levels (6125 ng/mL) confirmed the diagnosis of prolactinoma, leading to initiation of medical treatment, with gradual escalation to maximum dosing. The patient achieved only partial hormonal response and incomplete improvement of symptoms, and therefore, surgical intervention was pursued with objective of maximum safe resection. The patient consented to the procedure. An endonasal endoscopic approach was selected. Surgical procedures encompassed transsellar, transtuberculum, and transplanum approaches, extended laterally to expose the right parasellar carotid and the anterior wall of the cavernous sinus. Subsequent steps involved opening the sellar and suprasellar dura mater, anterior wall of the cavernous sinus, and transcavernous hemipituitary transposition for access to the retrosellar region.1-5 Debulking of the lesion was performed, followed by dissection of the retrosellar space and resection of tumor component within the interpeduncular cistern. Reconstruction employed dura substitute and vascularized nasoseptal flap. Histopathology confirmed diagnosis of prolactinoma. Postoperative MRI findings and significantly improved prolactin levels (50 ng/mL) were compatible with near total resection. The patient's postoperative course was uneventful, resulting in discharge on the second postoperative day. The patient was additionally started on cabergoline 0.5 mg 2x/week to achieve hormonal control. This case demonstrates the application of surgical anatomy and its translation in modern surgical techniques that allow improved resection of such complex tumors while ensuring optimal clinical outcomes.

Population Pharmacodynamic Models of Risperidone on PANSS Total Scores and Prolactin Levels in Schizophrenia.

Currently, research predominantly focuses on evaluating clinical effects at specific time points while neglecting underlying patterns within the treatment process. This study aims to analyze the dynamic alterations in PANSS total scores and prolactin levels in patients with schizophrenia treated with risperidone, along with the influencing covariates. Using data from an 8-week randomized, double-blind, multicenter clinical trial, a population pharmacodynamic model was established for the PANSS total scores of and prolactin levels in patients treated with risperidone. The base model employed was the Emax model. Covariate selection was conducted using a stepwise forward inclusion and backward elimination approach. A total of 144 patients were included in this analysis, with 807 PANSS total scores and 531 prolactin concentration values. The PANSS total scores of the patients treated with risperidone decreased over time, fitting a proportionally parameterized sigmoid Emax model with covariates including baseline score, course of the disease, gender, plasma calcium ions, and lactate dehydrogenase levels. The increase in prolactin levels conformed to the ordinary Emax model, with covariates encompassing course of the disease, gender, weight, red blood cell count, and triglyceride levels. The impacts of the baseline scores and the course of the disease on the reduction of the PANSS scores, as well as the influence of gender on the elevation of prolactin levels, each exceeded 20%. This study provides valuable quantitative data regarding PANSS total scores and prolactin levels among patients undergoing risperidone treatment across various physiological conditions.

Dopamine D2 receptor antagonist counteracts hyperglycemia and insulin resistance in diet-induced obese male mice.

Obesity leads to insulin resistance (IR) and type 2 diabetes. In humans, low levels of the hormone prolactin (PRL) correlate with IR, adipose tissue (AT) dysfunction, and increased prevalence of T2D. In obese rats, PRL treatment promotes insulin sensitivity and reduces visceral AT adipocyte hypertrophy. Here, we tested whether elevating PRL levels with the prokinetic and antipsychotic drug sulpiride, an antagonist of dopamine D2 receptors, improves metabolism in high fat diet (HFD)-induced obese male mice. Sulpiride treatment (30 days) reduced hyperglycemia, IR, and the serum and pancreatic levels of triglycerides in obese mice, reduced visceral and subcutaneous AT adipocyte hypertrophy, normalized markers of visceral AT function (PRL receptor, Glut4, insulin receptor and Hif-1α), and increased glycogen stores in skeletal muscle. However, the effects of sulpiride reducing hyperglycemia were also observed in obese prolactin receptor null mice. We conclude that sulpiride reduces obesity-induced hyperglycemia by mechanisms that are independent of prolactin/prolactin receptor activity. These findings support the therapeutic potential of sulpiride against metabolic dysfunction in obesity.

Management peculiarities of patients with hyperprolactinemia in case of mass formations of the hypothalamic-pituitary region: a clinical case

Hyperprolactinemia is a condition characterized by persistently elevated blood prolactin level. The most prominent manifestations of it are reproductive dysfunction, as well as fat and carbohydrate metabolism disorders, including body weight gain, dyslipidemia, impaired glucose tolerance, and insulin resistance. We describe here a case of hyperprolactinemia in a young man and perform differential diagnosis of prolactinoma with craniopharyngioma. The article demonstrates that initiation of treatment with dopamine agonists allows us to make a correct diagnosis and to determine optimal tactic of management – either therapy or surgery.

Estimation of Fibulin-1, Chemerin and Omentin-1 in Iraqi Women with Polycystic Ovary Syndrome-Associated Infertility

Background: Adipokines (fibulin-1, chemerin, and omentin-1) affect the hypothalamic-pituitary-gonadal axis and ovarian steroidogenesis. Adipocyte-secreted adipokines are dysregulated in females with polycystic ovarian syndrome (PCOS). Objective: To investigate the role of serum fibulin-1, chemerin, omentin-1, total cholesterol (TC), high-density lipoprotein (HDL), triglyceride (TG), progesterone (PROG), and prolactin (PRL) in PCOS and the development of infertility. Methods: 150 PCOS, infertile PCOS women and control women aged 20–40 years were enrolled in this observational study and divided into three groups: 40 women who were control, 60 women who had PCOS only, and 50 women who had infertility and PCOS. Analyses of fibulin-1, chemerin, omentin-1, lipid profile, PROG, and PRL were performed for all participants. Results: The results showed elevated levels of fibulin-1, chemerin, and PRL in both PCOS and infertile PCOS when compared with control, while omentine-1 and PROG decreased in both PCOS and infertile PCOS when compared with control. The levels of TC, HDL, and TG weren’t affected in PCOS alone, but in cases of infertility, TC and TG increased while HDL decreased. Conclusions: The increased level of fibulin-1 may be a new marker for PCOS and infertility. Chemerin shows a high level in both infertile PCOS and PCOS women, while omentin-1 shows a low level in both infertile PCOS and PCOS women.

Investigating the association between hyperprolactinemia and thyroid autoimmunity in women

Aims: Hyperprolactinemia (HPRL), a condition characterized by elevated levels of prolactin (PRL) hormone, is considered to be related to various autoimmune diseases, such as thyroid autoimmunity (TAI). The association between HPRL and TAI still evokes controversy. Our study intends to examine the possible relationship between HPL and TAI in young women. Methods: This retrospective study was done between January 2018 and December 2022, including 90 women with HPRL and 90 control subjects of similar age and gender. A retrospective examination was conducted on the medical records of 90 patients with HPRL to gather relevant data. Information regarding related parameters was analyzed and compared to the control group data. Results: Our results found that thyroid stimulating hormone (TSH) levels were notably elevated in patients with HPRL compared to healthy women (2.24 vs. 1.86). Also, a statistically significant association between the case and control regarding serum free triiodothyronine (fT3) (p&lt;0.05). No statistically significant difference was found between the case and control regarding serum free thyroxin (fT4) (p&gt;0.05). Patients with HPRL demonstrated considerably higher anti thyroperoxidase antibody (anti-TPO) levels (46.08 vs. 43.95). Significantly elevated antithyroglobulin antibody (anti-Tg) levels were observed in patients with HPRL (1.07 vs. 0.84). Conclusion: The study suggests a potential link between HPRL and TAI. Further research is needed to explore this relationship and its implications for patient care.

SAT378 Unusual Case of Hirsutism From Prolactinoma Induced Dihydrotestosterone Elevation

Abstract Disclosure: J. Ambalavanan: None. K. Alkwatli: None. L. Tranchito: None. D. Yogi-Morren: None. P.P. Rao: None. Introduction: Hirsutism, in women of reproductive age, is a clinical marker of hyperandrogenism. PCOS is the most common cause while non-classic congenital adrenal hyperplasia, adrenal/ovarian tumors are other causes. While various biomarkers of hyperandrogenism like total testosterone(T), 17-Hydroxyprogesterone(17-OHP), DHEA-S are obtained during evaluation, isolated elevation in dihydrotestosterone (DHT) is rarely seen. We present a unique case of hirsutism where elevated prolactin (PRL) levels from a prolactinoma led to an increase in DHT levels resulting in hirsutism. Case Report: A 31-year-old female presented to the endocrine clinic for hirsutism. Her symptoms included increased chin hair and loss of scalp hair. Symptoms were progressively worsening for a year. Initial biochemical evaluation by an endocrinologist in her home country was significant for subclinical hypothyroidism (SCH) with TSH of 8 mIU/ml (0.35-4.94), elevated PRL of 49 ng/ml(2.8-29.2) and elevated DHT of 871 pg/ml (24-368). T, 17-OHP, DHEA-S were normal. It was believed that her SCH was driving her high PRL and she was started on levothyroxine 12.5 mcg daily along with finasteride 2.5mg daily for high DHT. She denied galactorrhea, breast tenderness headache, vision changes, and menstrual abnormalities. Repeat biochemical testing was performed during the follicular phase of menstrual cycle, after stopping all her pills for 2 weeks. Labs were significant for PRL-102 ng/mL (4.5-26.8), TSH-3.49 mIU/mL (0.27-4.2), total T- 47 ng/dL (8-60), free testosterone - 0.9 ng/dL (0.13-1.03), 17- OHP-70.3 ng/dL (&amp;lt;206), androstenedione-1.7 ng/mL (0.3-3.3), DHT-272 pg/mL (24-208), DHEA-S-386.8 ug/dL (98.8-340), LH-9 mIU/mL, FSH-7.2 mIU/mL. Due to the high prolactin, MRI of the pituitary was obtained and showed a 1.1 cm pituitary adenoma with extension towards optic chiasm. Due to the macroadenoma, we started the patient on cabergoline 0.25 mg p.o. weekly. On repeat testing 1 month after cabergoline, her prolactin normalized to 2 ng/mL (4.5-26.8), dihydrotestosterone normalized to 175.2 pg/mL (24-208), DHEA-S normalized to 220.2 mcg/dL (98.8-340). Conclusion: Elevated DHT is a very rare cause of hirsutism. In our patient, the elevated PRL levels were associated with high DHT and DHEA-S level. Though the exact mechanism of is unclear, studies in rats have shown that prolactin has an activating effect on the 5 alpha reductase enzyme and increases DHT levels. Additionally, treatment of the high PRL levels resulted in normalization of DHT levels. The high DHEA-S was not thought to be a cause of hirsutism as it was normal in the initial labs. Moreover, peripheral conversion would have resulted in high T and androstenedione levels which were normal in our patient. In our review of literature, we could not find any similar reports in human beings and would like to educate the endocrine community of this possible association. Presentation Date: Saturday, June 17, 2023

FRI430 A Case Of Elevated Sex Hormone-binding Globulin Secondary To Variegate Porphyria In A Patient With Hypogonadotropic Hypogonadism

Abstract Disclosure: J. Law: None. C. Yip: Research Investigator; Self; Eli Lilly &amp; Company. Background: Acute porphyria is a group of disorders characterized by enzymatic defects in the heme biosynthetic pathway. The liver is the source of both acute intermittent porphyria (AIP) and variegate porphyria. AIP is known to cause an elevation in sex hormone-binding globulin (SHBG) levels, likely secondary to impaired hepatic function and hepatocyte abnormalities1. We describe a case of elevated SHBG secondary to variegate porphyria, in a male with hypogonadotropic hypogonadism. Case Report: A 44-year-old male presented with an elevated SHBG and symptoms of hypogonadism with low libido, weakness, and fatigue. Fasting morning bloodwork revealed an elevated SHBG at 89 nmol/l (13.5- 71.0), a normal total testosterone level at 12.95 nmol/l (8-32), and a low bioavailable testosterone at 0.82 nmol/l (2.5-10), with confirmatory repeat blood work. His history was significant for longstanding variegate porphyria, manifesting as frequent attacks of abdominal pain. He was on opioids for greater then 10 years for his chronic pain, as well as metoclopramide. On assessment of causes for his elevated SHBG, his TSH was normal at 1.49 mIU/L (0.35-4.30). He did not have cirrhosis, hepatitis, hereditary hemochromatosis, and was not on anticonvulsants. No other cause was found, and his elevated SHBG was deemed secondary to his variegate porphyria. His normal total testosterone level was due to his elevated SHBG, but as mentioned, his bioavailable testosterone was low. His LH and FSH were both inappropriately normal, with his LH being 4.67 IU/L (0.6-12.0) and his FSH 4.7 IU/L (1.0-12.0), in keeping with hypogonadotropic hypogonadism. He went through normal pubertal development and had no anosmia. Workup revealed an elevated prolactin level of 73.8 ug/l (3.5-19.4). He had no galactorrhea or gynecomastia and an MRI sella revealed a normal pituitary gland. His elevated prolactin level was determined to be secondary to his opioid medication and/or metoclopramide use. His hypogonadotropic hypogonadism was deemed secondary to his opioid medications and/or hyperprolactinemia. Conclusion: This case demonstrated variegate porphyria as a likely cause of elevated SHBG, similar to AIP. In patients with variegate porphyria and symptoms of hypogonadism, the SHBG should be measured and if it is elevated, the bioavailable or free testosterone levels should be used in assess instead of relying on the total testosterone levels. As has been previously shown, this case also illustrated the use of opioid medications as a cause of hypogonadotropic hypogonadism.

SAT616 Differentiating Resistant Prolactinoma From Macroprolactinemia

Abstract Disclosure: S. Lacount: None. P. Belany: None. Introduction: Prolactinomas are the most common secretory tumor of the pituitary gland. Hyperprolactinemia can present as hypogonadism, infertility, galactorrhea, or it may remain asymptomatic. In asymptomatic hyperprolactinemia, macroprolactinemia and other secondary causes should be considered and ruled out. Prolactinomas treated with dopamine agonists typically respond well, with decreasing tumor size and prolactin level reduction. We present a case of a prolactinoma not responding biochemically or anatomically to maximum doses of dopamine agonists, concerning for resistant prolactinoma versus macroprolactinemia. Clinical Case: A 62 y.o. male with PMH of HTN, HLD and CAD who presented with fatigue and headaches in 2009. Initial work-up showed an elevated prolactin level to 178 ng/mL (reference range 2.0-18.0 ng/mL). MRI pituitary showed a 1.8 x 1.9 x 1.5 cm mass but without optic chiasmal compression. Patient refused medications and opted to pursue endoscopic endonasal approach (EEA), which was completed in March 2009. Pathology and hormonal immunostains confirmed prolactinoma. Due to persistently elevated prolactin levels following EEA, cabergoline was started. Follow-up MRI Pituitary in November 2012 showed stable heterogeneous residual tissue without tumor recurrence. Despite escalating cabergoline doses (up to 8 mg weekly), his prolactin levels remained slightly elevated (50 ng/mL) after surgery with unchanged symptoms from presentation. Due to the association of cabergoline and cardiac valve disease development, his dose was decreased back down to 0.5 mg twice weekly. Given his persistent asymptomatic hyperprolactinemia that was nonresponsive to high-dose cabergoline, there was consideration for macroprolactinemia causing a falsely high level. Screening polyethylene glycol (PEG) precipitation test in November 2022 was normal. MRI pituitary in December 2022 showed a progressive sellar lesion with increased size and cavernous sinus invasion near the carotid artery. Patient was referred to neurosurgery in January 2023 for further evaluation of potential resistant prolactinoma. Due to the MRI findings and persistently elevated prolactin levels, he will undergo repeat EEA in May 2023 for treatment of resistant prolactinoma. Conclusion: Dopamine agonists are very effective in treating prolactinomas. In asymptomatic hyperprolactinemia, PEG precipitation is an inexpensive test to screen for macroprolactinemia. Once macroprolactinemia and other secondary causes are ruled out, resistant prolactinoma can be considered. Resistant prolactinoma is defined by failure to achieve normoprolactinemia and at least 50% reduction in tumor size on maximum-tolerated therapy. Risk factors for resistant prolactinoma include larger tumor volume and male gender. Treatment options include different or increased dopamine agonist doses, radiotherapy and resection. Presentation: Saturday, June 17, 2023

THU100 Case Of A Large Suprasellar-clival Mass: Prolactinoma Vs Paraganglioma

Abstract Disclosure: L.N. Madera Marin: None. Y. Rivera-Nieves: None. M.A. Ortiz-Rivera: None. A. Rosado-Burgos: None. L. El Musa Penna: None. W. Medina-Torres: None. L. Sepulveda-Garcia: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. M. Alvarado: None. N. Canales: None. Introduction Prolactin secreting adenomas comprise 30-40% of all pituitary adenomas. Generally, serum prolactin levels correlate with tumor size. Giant prolactinomas measure &amp;gt;4 cm, most have mass related clinical effects. Even large masses respond to cabergoline. Some may require surgical intervention. We present a case of a large pituitary mass associated with elevated prolactin levels, but with an interesting histopathologic analysis. Patient Description 30 y/o male patient with new onset decreased peripheral vision. Retinologist evaluation showed no abnormalities. Laboratories done by PCP found with altered thyroid function tests, but no treatment offered at the time. Two months later, the patient complained of worsening peripheral vision and was found with a left dilated pupil. A head CT scan was performed that showed a large brain mass. Admitted for urgent neurosurgery evaluation and high dose dexamethasone was initiated. ROS was remarkable for weight gain over the past year, and decreased morning erections, although denied decreased libido or erectile dysfunction. MRI showed an infiltrative skull base tumor extending from the clivus to the parasellar area encasing the left cavernous segment of the internal carotid artery with expansion of the sella obliterating the pituitary gland, and extension into the left optic canal. Pre-operative laboratories: Prolactin &amp;gt;877 ng/ml (2-17ng/ml), Cortisol 1.80 mcg/dL (4-22 mcg/dL), TSH 1.45 uIU/ml (0.4-4.0 uIU/ml), Sodium 142mMol/L (135-145mMol/L). Patient underwent left pterional craniotomy. Initial intra-operative pathology: “Positive for Neoplasia”. Post-operative laboratories: Prolactin &amp;gt;877 ng/ml, TSH 0.229 uIU/ml, FSH &amp;lt;0.30 mIU/ml (1.2-7.8 mIU/ml), and LH 0.16 mIU/ml (1.5-9.3 mIU/ml). Case Outcomes/Discussion Central hypothyroidism and hypogonadism confirmed, secondary hypocortisolism could not be assessed due to emergent corticosteroid infusion upon admission. A presumptive diagnosis of a giant prolactinoma was made for which cabergoline therapy was initiated. Final pathologic diagnosis revealed a paraganglioma. Urine fractionated metanephrines and catecholamines were normal. Immunostaining for prolactin requested. Paragangliomas arise from neuroendocrine cells, from either sympathetic or parasympathetic ganglia and can be solitary or multiple. Skull base and neck paragangliomas are usually benign while ∼20% of abdominal paragangliomas (sympathetic) are malignant. Anterior skull base paragangliomas are predominantly located in the sella and are rare but have been described in the literature. Very rare cases of pheochromocytomas or paragangliomas associated to pituitary adenomas have been reported. It has been named as the three P association, thought to be related to succinate dehydrogenase B and D mutations. Moreover, there are no cases in the literature of paragangliomas secreting prolactin. Presentation: Thursday, June 15, 2023

FRI317 Simultaneous Occurrence Of A Pineal Germ Cell Tumor And Pituitary Macroprolactinoma In A Young Male

Abstract Disclosure: E.P. Monsour: None. S. Badour: None. J.M. Munoz Pena: None. W.T. Donahoo: None. Background: Germ Cell Tumors (GCTs) are a group of heterogeneous tumors that derive from pluripotent germ cells and originate in the yolk sac of the embryo in early gestation. They account for 10% of all central nervous system (CNS) GCTs, primarily occurring in the pediatric and adolescent populations. The co-existence of macroprolactinoma and a mixed CNS GCT is extremely rare, with an unknown worldwide prevalence. Here we report a case of a pituitary macroprolactinoma occurring with a separate primary CNS mixed GCT. Clinical Case: A 19-year-old male presented with a 2-month history of headaches associated with nausea and vomiting. Relevant physical exam findings included decreased visual acuity, absent facial and axillary hair, and prominence of the left testis. Brain MRI demonstrated a pituitary adenoma measuring 3.5 x 2.3 x 3.2 cm extending into the cavernous sinus and an enhancing necrotic lesion in the third ventricle measuring 5.0 x 3.7 x 4.9 cm. Testicular ultrasound revealed two sub-centimeter ill-defined masses in the left testis. Pre-operative labs showed intact thyroid, adrenal, and growth hormone axis. He had a low total testosterone [14.2 ng/dl, reference range (RR): 230-800 ng/dL] with inappropriately normal gonadotrophins and markedly elevated prolactin (PRL) level (2,517 ng/mL, RR &amp;lt;14 ng/mL). Testicular tumor marker, alpha-fetoprotein, was elevated (15.3 ng/dL, RR &amp;lt;9 ng/dL). He was started on glucocorticoids for vasogenic edema and cabergoline twice weekly. He underwent left orchiectomy and subsequent pineal tumor resection. Testicular tumor pathology was consistent with teratoma and a well-differential neuroendocrine tumor with negative margins. Pineal tumor pathology was diagnostic of a mixed GCT. Despite optimal medical therapy, the patient ultimately opted to pursue transsphenoidal tumor resection. Pituitary mass pathology was compatible with a pituitary adenoma, immunoreactive for PRL. Post-operative PRL levels decreased to 6 ng/dL. He achieved a surgical cure without the need to restart dopamine agonist therapy. Conclusion: Simultaneous occurrence of primary brain tumors with different pathologies is estimated to be ∼0.9% of all brain tumors. To our knowledge, only one other case report described an adolescent with a craniopharyngioma and intracranial GCT. This is the first report in the literature of a pituitary macroprolactinoma synchronous with a mixed CNS GCT, and testicular well-differential neuroendocrine tumor with teratoma. Presentation: Friday, June 16, 2023

FRI323 Prolactinoma Recurrence With Testosterone Treatment In Transgender Male

Abstract Disclosure: N. Arnouk: None. P.R. Schroeder: None. Introduction: We present a case of recurrent hyperprolactinemia due to testosterone treatment for gender-affirming hormonal therapy in a transgender male after being controlled on cabergoline for more than a year. Case: A 27-year-old female with history of HTN and polycystic ovary syndrome was diagnosed with pituitary microadenoma after hospital admission for headache and blurry vision. MRI brain showed a mass in the sella and right parasella measuring 36 mm W x 36 mm D x 44 mm H. Hormonal workup showed prolactin (PRL) &amp;gt;999 ng/mL in the diluted assay. The patient was treated medically with cabergoline and discharged home. PRL level improved to 22 ng/mL on treatment. Cabergoline was continued at 0.5 mg twice weekly. The patient was lost to follow-up but returned to clinic after 8 months with PRL level of 58 ng/mL. Cabergoline 0.5 mg twice weekly was continued. PRL level monitoring every ∼6 weeks showed an increase to 184 ng/mL and then 199 ng/mL. Cabergoline was increased to 1 mg twice weekly. PRL level 1 month later was 222 ng/mL. Repeat brain MRI showed markedly decreased microadenoma 4.8 X 2.6 mm. The patient was asymptomatic with no headache, blurry vision, or galactorrhea. On further questioning, the patient reported starting transgender female to male testosterone cypionate 200 mg/mL once weekly for the past 6 months. After discussion with the primary care provider who was managing testosterone treatment, he was started on 60 mg weekly, and the dose was gradually increased to 80 mg weekly to stop the menstrual period. With the 60-mg weekly cypionate dose, the testosterone level was 346 pg/mL, and PRL level was 184 ng/mL. With the cypionate dose of 80 mg weekly, PRL increased to 194 ng/mL and 222 ng/mL. The cypionate dose was decreased to 60 mg weekly, based on literature noting elevated PRL level with testosterone replacement in patients with prolactinoma and hypogonadism. Based on repeat blood work showing elevated testosterone 366 pg/mL with PRL 318 ng/mL, the plan is to start an aromatase inhibitor. Discussion: Testosterone treatment as hormonal affirming therapy in some transgender female to male patients may exacerbate pre-existing hyperprolactinemia or induce PRL secretion, thus close monitoring is required. Testosterone is aromatized to estradiol, which then stimulates the release of PRL from the pituitary gland. The serial measurement of estradiol may serve as an index of aromatization. Hyperprolactinemia in this setting is resistant to dopamine agonist therapy, as noted in multiple case reports. There are no established reference ranges for PRL levels for transgender patients on gender-affirming hormone therapy and no current guidelines regarding routine imaging or biochemical assessment during follow-up. Transgender patients with prolactinoma may require additional treatment with non-aromatizable androgens or the concomitant administration of aromatase inhibitors. Presentation: Friday, June 16, 2023

FRI397 An Unusual Case Of Galactorrhea- Think About Breast Implants !

Abstract Disclosure: P. rimal: None. C. Musurakis: None. J.L. Gilden: None. Introduction: Elevation of prolactin (PRL) levels can occur due to physiologic or pathologic disorders of lactotroph cells. The most common causes for hypersecretion and resulting galactorrhea (GAL), a milky breast discharge, are pregnancy, breast feeding, hypothyroidism, chronic kidney disease, medications, chest wall trauma, or even stress. Although GAL is a rare complication after breast augmentation or reconstruction surgery, it can be bilateral, ipsilateral or contralateral, and is thought to be self-limiting. GAL can be cosmetically and psychologically distressing. The treatment depends on identifying the underlying cause, severity of symptoms, and can be medical, surgical, and might even necessitate breast implant removal. Clinical case: A 34-year-old Latina female G3P2 AB1 with prediabetes (BMI=22), history of gestational diabetes, and migraine headaches, was referred to the endocrine clinic for elevated PRL levels and 2 years of persistent GAL. Although originally regular, she had 3 months of menometrorrhagia following a COVID booster. She denied recent pregnancy, breast-feeding, breast masses, hirsutism, symptoms of thyroid disorders, chest wall trauma, infection, or symptoms of pituitary dysfunction. She was not taking medications associated with PRL elevation. Upon further evaluation, she reported frequently massaging the bilateral cosmetic breast implants to avoid formation of scar tissue. Lab evaluation showed initial PRL elevation of 35.8 ng/mL (nl=2.8-29.2); with normal LH=10.9 mIU/mL(nl 1.9-12.5) and FSH =4.9 mIU/mL(nl 2.5-10.2); estradiol=200.89 pg/mL(19.5-144.2); progesterone &amp;lt;0.5 ng/mL(nl &amp;lt;0.8);urine pregnancy test negative, HCG normal &amp;lt;2.6 mIU/mL (nl 2.6-4.2) ; ACTH=14 pg/mL (nl 0-47); AM cortisol=13.33 mcg/dL; salivary cortisol=&amp;lt;0.03 and 0.05 mcg/dL(nl 0.004-0.56); free testosterone=3.2 pg/mL(nl 0.1-6.4); SHBG =83.55 nmol/L(nl 17.69-138.26) total testosterone slightly elevated 50 ng/dL (nl 2-45); DHEAS=215 mcg/dL(nl 35-430); normal thyroid tests [(TSH 1.06 uIU/mL(0.550-4.780 ), free T4=1.05 ng/dL(0.76-1.46) Thyroid peroxidase antibody 28 U/mL(0-60)], Pelvic Ultrasound-benign right ovarian cyst and left ovary with subcm. follicles. Normal MRI of pituitary. Mammogram-dense breasts with bilateral implants. A Repeat PRL was 20.4 ng/mL with monomeric PRL normal at 8.6 (3.2-25.2 ng/mL), and later 13.70 ng/mL after stopping massaging of the breasts. The etiology of GAL was attributed to the breast implants with massaging, after excluding all other potential causes. Conclusion: Although other etiologies for galactorrhea should be considered, breast implants with manipulation must always be thought of as a possibility. This case highlights the importance of taking a thorough and complete medical history when evaluating all patients with galactorrhea. Presentation: Friday, June 16, 2023

Phytocompositions of ayurvedic medicine in the restoration of menstrual health in women of early reproductive age who have survived moderate and severe form of COVID-19

Research objectives: to evaluate the effectiveness of phytotherapy in the treatment of menstrual health disorders in women of early reproductive age after a moderate and severe form of the coronavirus disease.Material and methods. 104 women of early reproductive age with menstrual health disorders that occurred 3 months later after moderate or severe COVID-19 were under observation and 34 gynecologically and somatically healthy women of the control group who did not suffer from COVID-19. Female patients with COVID-19 were randomly divided into two groups: the main group (n=53) and the comparison group (n=51). The performed examination included: study of complaints, general and gynecological anamnesis, physical and gynecological examination, ultrasound examination of pelvic organs, determination of hormonal profile. All patients with COVID-19 received a comprehensive rehabilitation program, which included diet therapy, vitamin and mineral complexes, psychotherapy. In addition to the complex rehabilitation program patients of the main group received ayurvedic phytocompositions Femicycle or Femimens for 6 months.Results. It has been established that the moderate and severe course of the coronavirus infection affects the reproductive system of early reproductive aged women and leads to menstrual health disorders, among which irregular menstruation, premenstrual syndrome and dysmenorrhea dominate. Levels of pituitary, adrenal, ovarian and thyroid serum hormones were within the reference norm in most cases, but have statistically significant deviations from similar indicators of healthy control women who did not have COVID-19. One-third of women of early reproductive age after moderate to severe COVID-19 had elevated prolactin levels. Ayurvedic phytocompositions Femicycle and Femimens in a comprehensive rehabilitation program for post-COVID menstrual health disorders led to a faster recovery of menstrual health and a full hormonal recovery.Conclusions. Ayurvedic phytocompositions Femicycle and Femimens are effective and safe naturopathic drugs for restoring menstrual health in women of early reproductive age after experiencing moderate to severe COVID-19.