Prolactin Levels Research Articles

Comparative Study of Prolactin Levels in Acne and Non-Acne Individuals among Adolescent

Background: One of the most prevalent dermatological conditions affecting adolescents is acne vulgaris. The production of acne vulgaris lesions is a result of hormonal imbalances that impact skin conditions. Prolactin (PRL) is widely known for its involvement in the formation and operation of the mammary glands in addition to its more than three hundred non-lactational activities. Objective: This study aimed to evaluate and compare prolactin levels in serum hormone between persons with acne vulgaris and those without acne. Materials and Methods: In this cross-sectional case control study, serum levels of prolactin were collected and estimated in 80 subjects consisting of 40 males and 40 females each; of which 20 were the control group and 20, the test group in each category respectively. Also, certain criteria’s were looked into such as subject’s age, state of health, menstrual patterns (for females) and much more. Data collected was analyzed using the Software Package for Social Sciences (SPSS). At the end of the experiment, the result showed no significant change (p<0.05). Result: In both male and female adolescents, the mean serum prolactin level of those with acne was higher than that of those without the condition. In adolescents with acne, the mean serum prolactin level was higher (19.48 ± 11.04) than in those without acne (13.48 ± 5.22). P less than 0.05 indicated statistical significance. Conclusion: An increase in the mean serum prolactin levels of acne subjects in both categories when compared to non-acne subjects indicates the contribution of prolactin in the pathogenesis of acne.

Evaluation of anterior pituitary hormone levels in patients with atrial fibrillation

Aim: The risk of ischemic stroke is increased 5-fold in patients with atrial fibrillation (the most common reason for cardiac arrhythmia). The aim is to investigate whether insufficiency in anterior pituitary hormones develops in patients diagnosed with atrial fibrillation and no history of cerebrovascular accident. Method: A group of 65 patients with chronic /paroxysmal atrial fibrillation without a history of cerebrovascular accident and a group of 65 healthy controls without arrhythmia were included in this study. Atrial fibrillation was diagnosed by electrocardiography or 24-hour rhythm holter. Demographic data, biochemical tests, echocardiography findings were compared between the groups. P<0.05 was considered statistically significant. Results: There was no statistical difference in gender and age distribution between groups (p<0.05). (Patient group: Mean age 68 ± 7 years (16 (24.6%) male and 49 (75.4%) female) / Control group: Mean age 67 ± 6 years (18 (27.7%) male and 47 (72.3%) female). Serum insulin-like growth factor-1, adrenocorticotropic hormone and cortisol levels were significantly lower in the patient group compared to the control group (p=0.048, p=0.005, p=0.023). There was no significant difference in serum thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels between groups. Left atrial diameter and left ventricular end-diastolic diameter were higher in the patient group (p<0.0001). The left ventricular ejection fraction value was lower in the patient group (p<0.0001). Conclusion: It was thought that the reason for the low level of insulin-like growth factor-1 in the setting of normal liver and kidney functions and simultaneous cortisol and adrenocorticotropic hormone deficiency, in patients with atrial fibrillation with no history of cerebrovascular accident might be due to silent cerebral ischemia leading to pituitary dysfunction.

Metabolic Syndrome in Reproductive Age Women of Various Ethnic Groups. Neuroendocrine Status and Lipid Peroxidation System.

We analyzed the state of neuroendocrine regulation and LPO-antioxidant defense systems in reproductive age women with metabolic syndrome (MetS), representatives of the Russian and Buryat ethnic groups. Compared to the corresponding control groups, women from the Russian ethnic group with MetS had elevated levels of thyroid-stimulating hormone and free androgen index (FAI) and reduced levels of sex hormone-binding globulin, while women from the Buryat ethnic group had increased levels of prolactin and FAI. Changes in the LPO system in women of the Russian ethnic group with MetS consisted in an increase in the levels of substrates with double bonds, TBA-reactive substances, and fat-soluble vitamins. Buryat women with MetS had a higher content of primary oxidation products and reduced levels of glutathione. The results of the study indicate a hyperandrogenic shift in the neuroendocrine regulation system, as well as compensatory influences from different parts of the antioxidant defense system in women of reproductive age with MetS, depending on their ethnicity. These findings indicate the need for assessing and monitoring the levels of these metabolites in women with MetS, considering their ethnicity.

Increased Cardiometabolic Risk in Men with Hypoprolactinemia: A Pilot Study

Low prolactin levels in men predispose them to mood disturbances, sexual dysfunction, and diabetes. The purpose of the current study was to assess cardiometabolic risk in males with hypoprolactinemia. This prospective study included three age-matched groups of young and middle-aged men: individuals with cabergoline-induced hypoprolactinemia (n = 15), cabergoline-treated subjects with prolactin levels within the reference range (n = 20), and untreated men with normal prolactin levels (n = 31). In men with hypoprolactinemia, the cabergoline dose was reduced in order to normalize prolactin concentration. Anthropometric parameters, blood pressure, QRISK3 score; plasma concentrations of prolactin, glucose, insulin, lipids, uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and testosterone; whole-blood levels of glycated hemoglobin (HbA1C); urinary albumin-to-creatinine ratio (UACR); and carotid intima–media thickness were assessed at baseline and six months later. Men with hypoprolactinemia were characterized by higher body mass index, fat content, waist circumference, systolic blood pressure, fasting and 2 h post-load glucose, HbA1C, HOMA1-IR, uric acid, hsCRP, fibrinogen, homocysteine, and UACR; by lower HDL cholesterol and testosterone; by greater intima–media thickness; and by a higher QRISK3 score than their peers with normal prolactin levels. There were no statistically significant differences in the measured parameters between both groups of men with normal prolactin levels. Normalization of prolactin concentration was accompanied by normalization of biochemical variables, systolic blood pressure, and QRISK3 score. Although cabergoline dose reduction did not cause statistically significant changes in the remaining anthropometric parameters and intima–media thickness, six months later, they did not differ from those observed in the remaining study groups. Our findings suggest that iatrogenic hypoprolactinemia is associated with increased cardiometabolic risk, which is reversible and resolves after the normalization of prolactin levels.

What do we know about abnormally low prolactin levels in polycystic ovary syndrome? A narrative review.

Hyper and hypoprolactinemia seem to be related to the occurrence of metabolic alterations in PCOS patients. In contrast, between significantly elevated and significantly low, prolactin levels seem to be protective against metabolic consequences. In the present review, we found 4 studies investigating hypoprolactinemia in patients with PCOS. We also identified 6 additional studies that reported low levels of PRL in PCOS patients. Although its prevalence is not considered high (13.2-13.9%), its contribution is certainly significant to the metabolic alterations observed in PCOS (insulin resistance, obesity, diabetes mellitus, and fatty liver disease). Dopamine inhibits the secretion of prolactin and GnRH. If dopamine levels are low or the dopamine receptor is less expressed or mutated, the levels of prolactin and GnRH increase, and consequently, LH also increases. On the other hand, hyperprolactinemia, in prolactinomas-typical levels, acting through kisspeptin inhibition causes GnRH suppression and hypogonadotropic hypogonadism. In situations of hypoprolactinemia due to excessive dopamine agonist treatment, dosage reduction is important to minimize the decrease in prolactin levels. Nevertheless, there is a lack of prospective studies confirming these hypotheses, as well as randomized clinical trials with appropriate drugs targeting both hyperprolactin and hypoprolactin in patients with PCOS.

A case report of adolescent lactation due to the drug blonanserin

BackgroundSecond-generation antipsychotic drugs are increasingly used to treat depressive disorders with psychotic symptoms. In addition to effectively managing psychotic symptoms, second-generation antipsychotics can also result in adverse drug reactions in patients, which should not be underestimated.Case presentationWe report the case of 14 years old unmarried female patient with depression. At first, she started with moping and gradually developed into self-injury and whispering. After antidepressant treatment combined with the second-generation antipsychotic drug blonanserin, the patient’s psychotic and depressive symptoms improved significantly, while the patient developed lactation, which stopped after the medication was changed.ConclusionsAlthough Blonanserin’s clinical trials have reported rare adverse reactions like elevated prolactin levels and even lactation, caution is still needed in clinical application of the drug. This case is expected to improve psychiatrists’ choice of antidepressant therapy in combination with antipsychotic drugs.

Enhancing oxytocin and prolactin levels to address oligogalactia through emotional management and massage in working mothers

Emotional management, combined with oxytocin massage and breast care, offers a comprehensive approach to boost prolactin release, enhance milk production, and improve breastfeeding outcomes. The aim of this study was to evaluate the effectiveness of combining emotional management with oxytocin massage and breast care in increasing oxytocin and prolactin hormone levels to address oligogalactia in working postpartum mothers. A quasi-experimental study was conducted at Kudus Community Health Center, Kudus Regency, Central Java, Indonesia, from January to March 2024. A total of 93 postpartum mothers were randomly assigned to three groups: (1) emotional management with oxytocin massage; (2) emotional management with breast care; and (3) lactation education only. Blood samples were collected before and after the interventions to measure oxytocin and prolactin levels. The present study found that emotional management combined with oxytocin massage significantly increased oxytocin levels from 505.0±264.0 pg/mL to 600.0±231.3 pg/mL (mean difference: 103 pg/mL; p=0.002) and prolactin levels from 191.0±67.3 ng/mL to 233.0±86.8 ng/mL (mean difference: 27 ng/mL; p=0.001). The emotional management and breast care group showed a smaller increase in oxytocin (362.0±175.1 pg/mL to 418.0±185.1 pg/mL; mean difference: 23 pg/mL; p=0.048) and a significant increase in prolactin (195.0±48.8 ng/mL to 255.0±82.3 ng/mL; mean difference: 38 ng/mL; p=0.049). In contrast, the lactation education group showed no significant changes in oxytocin (p=0.756) or prolactin levels (p=0.341). In conclusion, emotional management combined with oxytocin massage significantly increased both oxytocin and prolactin levels, suggesting that integrating emotional management and oxytocin massage may be an effective strategy for postpartum lactation support.

Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma.

Prolactinomas are the most prevalent type of pituitary neuroendocrine adenomas, primarily affecting women of reproductive age. Unlike other pituitary tumors, the first-line management has traditionally been pharmacological rather than surgical. This preference is due to the effectiveness of dopamine agonists (DAs), which typically reduce tumor size and normalize prolactin levels in most patients. However, this does not imply that there is no room for improvement; the duration of treatment and medication side effects often lead to compliance issues among patients. Recent advances in surgical techniques and molecular biology have paved the way for the development of precision medicine, allowing for more flexible and personalized treatment strategies for prolactinomas. This review aims to enhance clinical decision-making and patient care for endocrinologists by focusing on several key factors: predictive markers of DA sensitivity, clinical characteristics and suitability for transsphenoidal adenomectomy as a potential first-line treatment, factors determining the successful withdrawal of DAs after prolonged use, safety concerns during pre/post-pregnancy and breastfeeding, and determinants of tumor aggressiveness. Through tailored therapy-a patient-focused, multidisciplinary approach- we aim to improve the management of prolactinoma patients.

The homeo-FIT-prolactin hypothesis: the role of prolactin in metabolic homeostasis - association or causality?

The homeo-fit-prolactin hypothesis proposes a causal metabolic role for prolactin with hypoprolactinemia and hyperprolactinemia leading to adverse metabolic alterations. However, prolactin within the normal range and up to four times the upper reference limit may be a consequence of metabolic adaption and have a positive metabolic role similar to increased insulin in pre-diabetes. As a consequence, drugs that would increase prolactin levels within this threshold may hold promising effects, particularly for patients with type 2 diabetes. A documented positive metabolic effect of prolactin just above the normal threshold would not just be of benefit to patients with diabetes but assist in the decision to treat mild hyperprolactinemia in other patient groups as well, e.g. drug-induced hyperprolactinemia or idiopathic hyperprolactinemia. Prolactin receptors are present in the pancreas, liver, and adipose tissue, and pre-clinical studies suggest a positive and causal effect of prolactin on the gluco-insulinemic profile and lipid metabolism. This narrative review examines the evidence for the homeo-fit-prolactin hypothesis with a particular focus on results from human studies.

7497 Association between Plasma Prolactin Levels and Menopausal Vasomotor Symptoms

Abstract Disclosure: F. Galbiati: None. J. Kang: None. D.J. Cote: None. J.E. Manson: None. U.B. Kaiser: None. Background: High prolactin (PRL) levels inhibit gonadotropin-releasing hormone (GnRH), causing hypogonadism. GnRH release is regulated by neurokinin B (NKB) and kisspeptin. NKB antagonists are used in treatment of menopausal hot flashes and vasomotor symptoms (VMS). In mice and humans with hyperprolactinemic anovulation, kisspeptin restored ovarian cyclicity and LH pulsatility. However, the interplay between kisspeptin and PRL is not fully understood. In two menopausal women with hyperprolactinemia and central hypogonadism, treatment with bromocriptine led to PRL normalization and new-onset VMS, suggesting that hyperprolactinemia inhibited VMS associated with hypogonadism. We aimed to investigate the association between PRL and menopausal VMS in women from the Nurses’ Health Study I and II (NHS, NHSII). We hypothesized that women with higher PRL levels would have a lower frequency/severity of menopausal VMS. Methods: We conducted a cohort study of 2618 females enrolled in NHS (n=1692) and NHSII (n=926) in whom blood samples were collected between 1989-99, were not pregnant or on hormonal therapy, and were either pre or post-menopausal as of blood draw. Subjects were free of breast, ovarian and other cancers, and provided complete data on VMS at menopause as well as in the past 4 weeks (assessed in 2008 in NHS and 2009, 2013, 2017 in NHSII). Plasma PRL was measured as part of 28 case-control studies of various health outcomes. We evaluated the presence and severity of VMS at menopause and 4 weeks prior to the questionnaire, as well as duration (in years) of VMS. We used multiple logistic regression, adjusting for covariates to estimate multivariable-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs). Results: Women were aged 33-65 years at blood draw; range for years from blood draw to menopause was -10 to 10 (median=1.8) years; range for years from blood draw to report of VMS (both at menopause and current VMS) was 9.8 to 22 years. Mean PRL (SD; range) was 14.7ng/mL (10.1; 0.08-246). Women with the highest PRL levels were likely to be younger and less likely to be current smokers or obese. 77.4% of women reported VMS at menopause and 47.6% in recent 4 weeks; 52.3% reported moderate-to-severe VMS at menopause and 32.0% reported VMS in recent 4 weeks. Overall, PRL was not associated with duration of VMS or moderate-to-severe VMS at menopause or in the past 4 weeks; compared to the lowest quintile (≤8.0ng/mL), those in the highest PRL quintile (≥18.2ng/mL) had MVRR of 1.23(95%CI=0.94,1.60) for moderate-to-severe menopausal VMS and 1.03(95%CI=0.67,1.59) for recent VMS. Menopausal status did not affect the association between prolactin levels and VMS. Conclusion: PRL levels were not associated with occurrence, severity, or duration of menopausal VMS in a large cohort of women. Presentation: 6/1/2024

12265 Isolated Adrenocorticotropic Hormone Deficiency In The Setting Of Anti-PD1 Immunotherapy

Abstract Disclosure: J. Poncelet: None. Q. Wang: None. A.J. Montero: Advisory Board Member; Self; AstraZeneca, Gilead. Other; Self; Medical Advisor for Paragon Infusion Services. L. Tranchito: None. Isolated Adrenocorticotropic Hormone Deficiency in the Setting of Anti-PD1 Immunotherapy Introduction: Immune checkpoint inhibitors have been associated with endocrine immune-related adverse events, such as secondary adrenal insufficiency with isolated ACTH deficiency in rare instances. Case Presentations: We present two different cases of isolated ACTH deficiency (IAD) while on anti-PD1 therapy with pembrolizumab. Patient A is a 66-year-old woman with history of tobacco use, hypertension, and COPD diagnosed with stage IV lung adenocarcinoma. After completing 15 cycles of pembrolizumab, she reported symptoms of fatigue, weakness, lightheadedness, and was subsequently admitted to the hospital for symptomatic hyponatremia. Lab workup revealed a morning cortisol level of 0.6 ug/dL (n2.5-20 ug/dL) and ACTH <1.5 pg/mL (n7.2-63.3 pg/mL), both of which had previously been normal. Her TSH was mildly elevated with a normal free T4. Her FSH, LH, prolactin, and IGF levels were normal as was MRI of the pituitary. She therefore was diagnosed with IAD and started physiologic steroid replacement therapy with hydrocortisone with subsequent symptomatic improvement and normalization of her serum sodium. Patient B is a 60-year-old woman with a history of osteoporosis, aortic stenosis, and stage II triple negative breast cancer treated with neoadjuvant chemotherapy and pembrolizumab. Two months after starting immunotherapy, she presented to her oncology office with symptoms of fatigue, poor appetite, body aches, and dizziness. Her labs revealed mild hyponatremia, cortisol of 0.9 ug/dL (n2.5-20 ug/dL) and ACTH <1.5 pg/mL (n7.2-63.3 pg/mL). TSH, LH, FSH, and prolactin levels were normal. She started physiologic steroid replacement therapy with hydrocortisone for IAD, which led to improvement in her symptoms. Both patients continue pembrolizumab. Conclusions: Immune-related adverse events affecting endocrine pathways have been reported with immune checkpoint inhibitors. There is no method to predict which patients may be affected, and no guidelines exist on when or how often to monitor hormone levels in these patients. Importantly, patients can continue immune checkpoint inhibitors despite IAD if controlled by hormone replacement, though ACTH recovery should not be expected[1]. Recognition of symptoms can prompt earlier evaluation for secondary adrenal insufficiency and provide greater benefit to patients. 1.Schneider BJ, Naidoo J, Santomasso BD, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update [published correction appears in J Clin Oncol. 2022 Jan 20;40(3):315]. J Clin Oncol. 2021;39(36):4073-4126. doi:10.1200/JCO.21.01440 Presentation: 6/1/2024

6534 Schwannoma-Induced Hyperprolactinemia: A Rare Presentation Unveiled

Abstract Disclosure: G. Naronowicz: None. F.F. Foo: None. J. Cheng: None. R. Ong: None. S.W. Holland: None. K. Chalasani: None. Background: This case describes a rare presentation of a schwannoma manifesting with hyperprolactinemia. Case Description: A 37 year-old female with a past medical history including prolactinoma presented to our endocrine office to establish care. Prior to presentation, this patient had been diagnosed with a prolactinoma in 2015 via MRI. She was started on Cabergoline 0.5mg twice a week for treatment and continued this medication without any bothersome side effects. However, she began experiencing progressive dizziness, tinnitus, bilateral galactorrhea, and vision changes, prompting her to seek further intervention. The patient presented to our endocrine office in October 2017 for her initial visit. Due to ongoing symptoms, an MRI was done which revealed an adenoma vs hyperplasia of the pituitary gland. During this time her prolactin level was within normal limits, thus she continued her Cabergoline regimen. Soon thereafter, the patient was seen again in April 2018 with evidence of stable prolactin levels on Cabergoline treatment, although a repeat MRI showed a concern for a 1.2 cm mass in the left cerebellopontine angle extending to the right auditory canal. The patient underwent a follow-up consultation with a neurosurgeon; However given the unavailability of surgery at that time owing to insurance-related matters, a subsequent MRI was performed in August 2019 which revealed a vestibular schwannoma with no pituitary mass, and she ultimately underwent resection of this mass in February 2020. Throughout this period, the patient presented with a rise in prolactin levels (23.7 to 41.9 ng/mL). However, due to an asymptomatic state and the absence of concerning pituitary mass, the decision to be observed off Cabergoline therapy appeared to be the appropriate clinical course of action. Following the surgery, she was seen again in June 2020 with normalization of her prolactin levels without ongoing cabergoline treatment. We continue to follow this patient to present day for annual appointments and she continues to have normal prolactin levels. Conclusion: This report underlines the importance of a thorough and multidisciplinary approach in the assessment of elevated prolactin levels in light of a schwannoma. This also highlights the significance of continued surveillance and the value of repeat imaging. Exploring alternative diagnoses, such as Schwannoma, broadens the scope of etiologies, thus allowing a comprehensive approach for accurate diagnosis. Presentation: 6/1/2024

7120 Pituitary Prolactinoma Transforming To Invasive Aggressive Adenoma After 10 Years of Acting As Benign Adenoma

Abstract Disclosure: S.N. Polis: None. S. Nakhle: None. N.J. Vernetti: None. Prolactinomas are the most common type of secretory pituitary tumors. Symptoms occur due to hyperprolactinemia and compressive symptoms with larger tumors. The majority of the prolactinomas are benign adenomas, with up to 30-40% of them being invasive. Malignant prolactinomas are rare, counting only 0.2% of pituitary tumors with an average latency period of 4.7 years. We present a 70-year-old woman who was found to have asymptomatic mild hyperprolactinemia in 2009 with pituitary MRI that showed a 3 mm left pituitary adenoma. Treatment with cabergoline started three years later due to an increase in prolactin above 300 ng/ml. Annual pituitary MRI showed a stable mass. After four years of treatment, pituitary MRI showed an increase in pituitary adenoma size to 8 mm and prolactin level remained elevated above 300 ng/ml. The patient complained of facial and acral numbness and emotional outbursts, so cabergoline was changed to bromocriptine. A few months later, a decision was made to stop treatment as she was asymptomatic and prolactin levels remained stable with a stable adenoma on imaging. 18 months later, prolactin increased to 544 ng/ml and pituitary MRI showed an increase adenoma size to 14mm, contacting the chiasm, and cabergoline was restarted. The prolactin levels continued to climb after 5 months of treatment despite titrating the dose to 1 mg daily. The patient started to develop vision impairment and visual field testing confirmed a new central vision defect. The patient was eventually referred to neurosurgery and went for transsphenoidal surgery. Prolactin level dropped to 50 ng/ml post operatively. The pathology report showed Ki 67 10-20%. Cabergoline was restarted and the patient was enrolled in a clinical trial for temozolomide for 18 months. During that time, prolactin levels remained stable so treatment was discontinued. A year later, cabergoline was restarted as prolactin levels increased to 219 ng/ml and pituitary MRI showed an 8 mm sellar mass with optic chiasm compression. For the next year, multiple medical treatments including high dose cabergoline (1 mg daily) and temozolomide were attempted, which were intolerable due to side effects. Prolactin continued to climb (> 1700 ng/ml). Four years later, the patient went for a second transsphenoidal surgery. Surgical pathology revealed Ki67 20%. Prolactin levels dropped to 242 ng/ml, but a month later, went up again to over 600 ng/ml. Cabergoline was restarted with a plan for an open craniotomy and radiotherapy. Conclusion: We present this interesting case of pituitary prolactinoma that behaved as benign adenoma for over 10 years prior to invasion and showing aggressive behavior requiring multiple surgeries. This unusual presentation is worrisome for malignancy and prompting consideration for closer and longer follow up for prolactinomas, especially the ones resistant to medical treatment. Presentation: 6/2/2024

7883 Atypical Presentation of Macroprolactinoma: Discordantly Low Serum Prolactin and Therapeutic Challenges

Abstract Disclosure: S. Hossain: None. M.S. Hossain: None. B. Gautam: None. S.C. Kumar: None. H. Liao: None. D.S. Rosenthal: None. Introduction: Pituitary tumors are categorized as microadenomas (<1 cm) and macroadenomas (>1 cm) with prolactinomas being one of the most common causes. The mean prevalence of prolactinomas is 10 per 100,000 in men and 30 per 100,000 in women. Serum prolactin levels corresponds to the size of the prolactinoma and any discrepancy should be treated with caution as that may indicate co-existence of pluripotent cells. We present a patient who presented with visual field defect and headaches, found to have a pituitary macroadenoma with discordantly low serum prolactin level compared to the size of adenoma, prompting a change in the treatment course. Case Presentation: A 42 year old male with no past medical history was seen as an endocrinology consult requested by neurosurgery for frequent headaches and visual problems for 1 year. Vital signs were normal, with negative orthostatic drop of blood pressure. He had prominent bitemporal hemianopsia confirmed by formal visual field testing by Ophthalmology. No galactorrhea or features suggestive of acromegaly or hyperthyroidism. He complained of erectile dysfunction but appeared to have normal male secondary sexual characteristics. MRI of brain showed a suprasellar mass measuring 3.8 x 2.6 x 2.2 cm with mass effect on the optic chiasm, hypothalamus with extension and infiltration into the right cavernous sinus. Lab results showed elevated prolactin of 1343.5 ng/ml confirmed by serial dilution, low serum testosterone level of 134 ng/dl and inappropriately normal FSH and LH. Complete blood counts, comprehensive metabolic panel, TFT, ACTH, cortisol and IGF-1 were normal. Patient was started on bromocriptine and he noticed improvement in his field of vision and acuity within one week of starting therapy. He continued to show sustained improvement in vision and resolution of his headaches at the one-month mark. MRI 2 months from starting bromocriptine showed modest reduction in size of the tumor to 2.1 x 2.3 x 2.4 cm with continued mass effect on the optic chiasm. Prolactin level decreased to 69.3 ng/ml. Therefore, although there was some improvement in visual fields, surgical resection was recommended to alleviate the mass effect on the optic chiasm. Conclusion: Our case highlights the significance of identifying discrepancies between the size of a prolactinoma and serum prolactin levels. Expected prolactin level from a prolactinoma similar in size to our case would be >3000 ng/ml when ours was 1343.5ng/ml. Despite undergoing treatment and lowering of prolactin levels our patient's pituitary adenoma did not significantly reduce in size after two months of treatment with bromocriptine and the mass continued to exert pressure on the optic chiasm. This suggests possible presence of pluripotent cells in addition to prolactin-producing cells within the tumor. The recommended course of action was surgical resection of the mass. Presentation: 6/1/2024

7013 An Inpatient Perspective: Hyperprolactinemia and Granulomatous Mastitis

Abstract Disclosure: A. Le: None. J. Wade: None. K. Martz: None. D. Girgis: None. M. Shahlapour: None. M.H. Horani: None. Introduction: Mastitis is a highly prevalent condition impacting thousands of women every year. Most commonly associated with lactation, mastitis is estimated to impact 2-20% of lactating women particularly in the first 4-6 weeks of breastfeeding (Wilson et al., 2020). The majority of cases are associated with bacterial infection with Staphylococcus aureus precipitated by nipple trauma and hyperlactation in the setting of genetic predispositions and disturbances to the human milk microbiota (Fernández et al., 2020). In rare cases, mastitis is seen outside of the context of lactation. One cause of non-lactational mastitis is idiopathic granulomatous mastitis (IGM). The pathogenesis of IGM is poorly understood, but there has been a rare association between IGM and hyperprolactinemia reported in the literature (Nikolaev et al., 2016). Case Presentation: In January 2022, A 20 year old female with past medical history of type 2 diabetes mellitus and hypertension, initially presented to the emergency department with complaints of headache. Patient’s history is notable for two years of amenorrhea and periodic nipple discharge. MRI scan of the head revealed a 1.6 cm pituitary macroadenoma which correlated with a markedly elevated prolactin level at 533.3. She was discharged with a prescription for Cabergoline 0.5 mg BID. In July 2022, the patient presented to the ED complaining of severe left breast pain with associated discharge for 4 days. She admitted to being non-adherent to Cabergoline treatment since April 2022 due to lack of endocrine follow-up. CT of the breast at that time showed a 3.8 cm subareolar abscess. Aspiration of the abscess revealed non-purulent fluid and cultures of the aspirate were negative. In February 2023, patient presented for right breast pain with a similar workup to previous hospitalization. MRI of the brain revealed a 1.6 cm sellar mass is unchanged since January 2022. Prolactin level was elevated at 652.4. Patient stated she has been off Cabergoline for the prior 5 months. She was subsequently seen for right and left mastitis 3 times over the next 12 months. Upon endocrine consultation, the patient was counseled on the importance of Cabergoline treatment in regression of future mastitis episodes, and the patient has subsequently not returned to our service. Conclusion: This case demonstrates the rare association between prolactin secreting pituitary adenomas and granulomatous mastitis that clinicians need to consider in order to avert delays in treatment and unnecessary hospitalizations. Specifically, when working up a patient with a history of IGM and prolactinemia, it is imperative to monitor prolactin levels periodically over an extended course of time with appropriate MRI imaging of the pituitary gland to assess for regression of prolactinoma and episodes of IGM. Presentation: 6/1/2024

6555 Cabergoline-induced psychiatric symptoms in a patient with a pituitary macroadenoma

Abstract Disclosure: G.S. Patel: None. J. Prater: None. Cabergoline is a long-acting dopamine agonist that is used for the treatment of hyperprolactinemia, especially in pituitary macroadenomas. It reduces the levels of prolactin (PRL) but is also effective in reducing the tumor size and allows patients to avoid undergoing surgical resection of the mass. It commonly causes side effects such as abdominal pain, bloating, dizziness, and headaches. It rarely can cause new onset psychological side effects or an exacerbation of pre-existing mood and behavioral disorders. We present the case of a male on cabergoline therapy who had new-onset psychiatric symptoms that persisted even after treatment was discontinued. The patient is a 40-year-old male who was found to have a pituitary macroadenoma measuring 2.2 x 1.8 x 1.6 cm on brain MRI after a one-year history of headaches, dizziness, and hearing loss. His vital signs and physical examination were unremarkable. Laboratory investigations revealed a PRL of 1,072 ng/mL. He was started on cabergoline 0.25 mg twice a week which reduced levels of PRL to 465.3 ng/dL. Throughout the next year, his PRL levels remained persistently elevated to >100 ng/dL and the cabergoline dose was steadily increased to 1 mg three times per week. About a year into treatment he began experiencing significant emotional lability, a tendency to cry, and bursts of temper which required the addition of multiple psychiatric medications. After two years of continued psychiatric symptoms, there was an attempt to both reduce cabergoline doses and switch to escalating doses of bromocriptine, both of which resulted in a reduction of psychiatric symptoms but also significant increases in PRL levels. The patient’s mood symptoms returned shortly after switching back to cabergoline, especially with increased doses. He eventually underwent trans-sphenoidal resection for his treatment-resistant pituitary macroadenoma. He was taken off cabergoline before surgery with a significant reduction in his mood symptoms but continues to require psychiatric medications for lasting emotional lability. Although rare, psychiatric side effects of cabergoline have been documented and must be addressed if a patient develops them while receiving treatment. Our patient had a severe presentation of mood symptoms from cabergoline therapy that required multiple psychiatric medications in escalating doses to control. It not only affected his quality of life but also resulted in long-term consequences. It is recommended that patients with similar presentations should be continued on cabergoline with the addition of clozapine as it has less of an effect on PRL levels. Other treatment options also include aripiprazole and quetiapine. However, when patients have treatment resistant macroprolactinomas and are unable to tolerate cabergoline, one would have to consider surgical treatment options for the treatment of hyperprolactinemia from pituitary macroadenomas. Presentation: 6/1/2024

8617 Gender Differences In The Course Of Giant Prolactinomas - Single-Centre Case Series

Abstract Disclosure: M.A. Komisarz-Calik: None. A. Boguslawska: None. K. Ciszek: None. G. Zieliński: None. A. Hubalewska-Dydejczyk: None. A. Gilis-Januszewska: None. Introduction: Giant prolactinomas are the specific subtype of lactotroph PitNET, and are classified, according to their maximum diameter (≥40 mm). They constitute about 3% of prolactinomas. The prevalence is more common in men, however, the differences in the course of the disease between the genders remain unclear. Aim: The purpose of our study was to analyse gender differences in the course of giant prolactinomas. Materials and Methods: We analysed the data of consecutive patients with giant prolactinomas treated in the tertiary clinical center in the years 2022-2023. Results: There were 12 patients with giant prolactinoma (10 men and 2 women).Men and women were of similar age (32 vs 36 years). The maximum dimensions of the pituitary tumour in men were 56x70x67 mm, in women 60x55x55 mm. In all cases, treatment included dopamine agonists (cabergoline in 11 patients (all male patients and one female patient) and bromocriptine in one woman. Combined treatment with temozolomide and pasireotide were implemented in two male patients. In three men (30%) a surgical treatment was performed due to the visual field disturbances and severe headaches. Multiple surgeries were performed in two patients due to recurrence of symptoms and tumour progression (surgery was performed twice, and three times). One male patient received radiotherapy.The most frequent symptoms were associated with insufficiency of the adrenal, thyroid, and gonadal axis (80% vs 50%), visual field deficits (50% vs 50%) and headache (80% vs 0%), respectively in men and women. In men, the most common symptom was hypofunction of the gonadal axis (8 cases - 4 isolated gonadal axis hypofunction and 4 cases - hypofunction of the adrenal, thyroid and gonadal axis). In one woman, hypofunction of the three pituitary axes was present. Serum prolactin was higher in men than in women (6576 - 284232 ulU/ml vs 2000 - 5659 ulU/ml). In total, after treatment, prolactin concentration decreased in 7 cases, 5 men (50%) and 2 women (100%). The decrease in prolactin levels in men was by 80,4-99,9%, while in women it was by 83,9-86,7%. Tumour shrinkage was observed in 7 cases - 6/10 men and 1/2 woman. In men, tumour size was reduced by 27,5-64,4%. Tumour progression was observed in three cases, in 1 case the dimensions were stable. In two cases due to a recent diagnosis, follow-up MRI has not been yet performed. In women, tumour reduction by 99,8% was observed; in second the size of the tumour remained stable. Conclusions: The prevalence of giant prolactinomas is higher in men. The most frequent symptoms in both genders are visual field disturbances. The prevalence of tumour shrinkage is similar in both sexes, however giant prolactinomas require surgery more often in men. Further multicenter projects are needed to study the course of giant prolactinomas and to improve the outcomes of care. Presentation: 6/3/2024

7826 The Identification of an Activating ESR1 Mutation in an Aggressive Prolactinoma Enabled the Use of Personalized Treatment

Abstract Disclosure: T. Paes: None. J.B. Mebarak: None. J. C. Magnotto: None. G. A. Stamatiades: None. Y. Kuang: None. C. Paweletz: None. E.R. Laws: None. R.S. Carroll: None. R. Jeselsohn: None. D. R. Mohan: None. A. Marcondes Lerario: None. W. L. Bi: None. D. A. Reardon: None. D. M. Meredith: None. U.B. Kaiser: None. A. Abreu: None. Introduction: Prolactinomas are benign tumors typically treated with dopamine agonists; few progress on medical therapy, through unclear molecular mechanisms. Although the SF3B1 mutation has been identified in one study as a driver of aggressive prolactinomas, in most cases no genetic mutations have been reported. We aimed to identify genetic alterations associated with prolactinomas using a gene panel. Method and Results: Oncopanel, a massively parallel sequencing panel, was performed to identify genomic variants and copy number variation (CNV) in a cohort of 21 patients with prolactinomas. No SF3B1 pathogenic variants were identified in this cohort. A MEN1 mutation was detected in a macroadenoma resistant to dopamine agonist. In a case of an extremely aggressive prolactinoma diagnosed in a 49-year-old woman, a somatic ESR1 [encoding estrogen receptor alpha (ERα)] mutation (ESR1Y537S) was identified in tissue from the patient’s fourth surgery. Using droplet digital PCR (ddPCR), ESR1Y537S was also detected in circulating cell-free DNA. We aimed to investigate whether ESR1Y537S may have driven initial tumor formation, or whether it was acquired as the tumor progressed. To this end, Sanger sequencing and ddPCR analyses of DNA from the first two resected tumors were performed and failed to identify ESR1Y537S. In the CNV analysis, the ESR1-mutated prolactinoma had the highest number of CNVs, compared to the rest of the cohort. Despite efforts to control tumor growth with multiple therapeutic modalities, the mutated prolactinoma had progressively enlarged post-menopausally, with invasion of surrounding structures. ESR1Y537S is a hotspot mutation in metastatic breast cancer. In breast cancer cells, ESR1Y537S activates the ERα independent of ligand binding, resulting in high cell proliferation and conferring resistance to classic hormonal treatment in ER-positive breast cancer. Elacestrant, a second-line ER degrader, increases overall free-survival in patients with resistant breast cancer and ESR1Y537S. Given the lack of response to multimodality therapy, off-label elacestrant was initiated after the third cycle of radiotherapy was completed in the patient with the aggressive prolactinoma. The combination of radiotherapy with this personalized treatment targeting ESR1 activity (elacestrant) was able to control tumor growth and significantly reduce prolactin levels. Conclusion:ESR1 regulates lactotroph differentiation and proliferation, possibly contributing to prolactinoma tumorigenesis. Our data support a role for ESR1Y537S in this prolactinoma’s unusually aggressive behavior in the postmenopausal setting. Molecular profiling revealing the mutation (ESR1Y537S) allowed the patient to receive a targeted therapy which, together with radiotherapy, resulted in a decrease in prolactin levels and a remarkable improvement in disease control. Presentation: 6/2/2024

8386 The Evolving Face of The Great Masquerader - Panhypopituitarism Associated with Neurosyphilis

Abstract Disclosure: M. Yabe: None. Z. Lin: None. F. Joseph: None. G. Philip: None. R. Silver: None. L. Callejas: None. J. Giunta: None. Untreated syphilis is on the rise in the United States. The CDC reported syphilis cases in newborns have increased 10-fold over a decade in November 2023, signifying the emergence of untreated infections. Pituitary involvement in syphilis is a very rare phenomenon, and endocrinological investigation is often overlooked. This will be the second reported case of neurosyphilis with pituitary involvement in a non-HIV infected patient. A 45-year-old female with no significant past medical history was admitted to the hospital with progressive neurological symptoms of intermittent left-side headache, hearing loss with tinnitus, and gait instability. Postcontrast MRI Brain revealed multifocal leptomeningeal enhancement involving supratentorial and infratentorial regions. Thickening of the enhanced pituitary infundibulum was also noted. Subsequent RPR titer showed 1:16 and lumbar puncture revealed CSF-VDRL titer 1:32, with pleocytosis 83 cells/uL, CSF-glucose 19 mg/dL, and CSF-protein 370 mg/dL. The patient completed Penicillin G 4 million/units intravenous every 4 hours for 14 days, with repeat MRI showing significant interval decrease in previously described extensive supratentorial and infratentorial leptomeningeal enhancement. However, there is no record of her sexual partner receiving treatment. The patient was readmitted one year later after a fall while displaying dysmetria. MRI Brain with contrast revealed a small subacute infarct along the right frontal corona radiata and pituitary gland measuring up to 1.2 cm in craniocaudal dimension compared to 0.4 cm on the prior exam. This prompted evaluation of pituitary hormones: FSH 0.8 IU/L, LH <0.3 IU/L, and ACTH 6.3 pg/mL, with normal serum growth hormone and prolactin levels. Further investigation revealed morning cortisol 2.5 ug/dL, thyrotropin < 0.2 uIU/mL, and free thyroxine 0.63 ng/dL. Radiological evidence is suspicious of inflammatory etiology of the pituitary gland. The patient was discharged with endocrinology follow-up and plan to perform a pituitary gland biopsy as an outpatient for confirmatory result. The association of neurosyphilis and hypophysitis leading to panhypopituitarism in a non-HIV infected patient was first reported in 2015. Since then, there remains limited research regarding their association due to rarity of pituitary involvement in neurosyphilis. With untreated syphilis on the rise and increased availability of MRI, clinicians should expect to encounter more cases of neurosyphilis with pituitary involvement in the future. Early detection of panhypopituitarism in those with positive CSF-VDRL titer could lead to better clinical outcomes. It is paramount that these cases are documented to emphasize pituitary involvement in neurosyphilis and encourage a low threshold to initiate endocrinological testing in the future. Presentation: 6/3/2024

7978 Metabolic Outcomes in Transgender Youth Receiving Affirming Hormonal Therapy

Abstract Disclosure: M. Salama: None. R. Basmaci: None. T. Rajjo: None. O. Chuzhyk: None. A.N. Lteif: None. A. Al Nofal: None. Objective: Heightened societal acceptance of transgender youth and increased awareness of their unmet medical needs have led to a rise in referrals for hormonal therapy. There is limited literature available on the metabolic outcomes of hormone therapy on transgender youth. We investigated how the different metabolic markers of cardiovascular disease change after the initiation of gender-affirming hormonal therapy in transgender adolescents. Methods: A Retrospective, observational cohort study based on chart review of all children with gender dysphoria (under 18 years of age) who were evaluated in the Pediatric Endocrinology Clinic in a tertiary care center between January 2015 and December 2022. Children's demographic information, baseline weight, height, BMI, hematocrit, lipid profile, ALT, prolactin, and HbA1C levels were obtained before and after the initiation of gender-affirming hormonal therapy. The Wilcoxon signed-rank test was employed for paired analysis, while the chi-square test was used as appropriate. Results: We identified 106 transgender youth who were included in the analysis, with a median age at the start of hormonal therapy of 16 years (IQR: 15-17); comprising 68 trans-males (64%) and 38 trans-females (36%). The median treatment duration was 34 months (IQR: 18-54). Among trans-males, ALT levels increased post-treatment (mean difference 6.851 U/L, p < 0.001), as did BMI Z scores (mean difference 0.257, p < 0.001) and LDL-C (mean difference 12.734 mg/dl, p = 0.002), triglycerides (mean difference 10.18 mg/dl, p = 0.009), non-HDL-C (mean difference 12.8 mg/dl, p = 0.002), and total cholesterol (mean difference 10.18 mg/dl, p = 0.02). No significant differences were observed in HbA1C and HDL-C post-treatment. Among transfemales, BMI Z-scores were higher post-treatment (mean difference 0.27, p = 0.007), with increased total cholesterol (mean difference 19.88 mg/dl, p = 0.008), LDL-C (mean difference 12.6 mg/dl, p = 0.02), and HDL-C (mean difference 11.38 mg/dl, p < 0.001). Other variables did not significantly differ pre-and post-treatment. Ten transfemales with measured prolactin levels pre- and post-treatment showed no statistically significant differences. Conclusion: This pilot study revealed increased BMI Z scores following the commencement of hormone therapy in both trans-male and trans-female youths. Moreover, masculinizing treatment led to increased ALT levels. Furthermore, the cardiometabolic profile exhibited diverse alterations, particularly higher LDL-C levels in both cohorts. These findings underscore the necessity for close monitoring of these parameters during the treatment of transgender youth. Larger prospective randomized controlled trials are essential to comprehensively assess the impact of gender-affirming therapy on transgender youth. Presentation: 6/2/2024