Modern approach to bone comorbidity in prolactinoma

Area of Science:

• Endocrinology
• Bone Metabolism
• Pituitary Disorders

Background:

• Prolactinomas are the most common pituitary adenomas, impacting fertility and bone health.
• Bone deterioration in prolactinoma patients stems from both prolactin (PRL)-induced hypogonadism and direct PRL effects.
• Inconsistent evidence exists on whether PRL directly harms skeletal integrity independent of hypogonadism.

Purpose of the Study:

• To review the mechanisms of prolactin's action on bone.
• To provide practical guidelines for managing skeletal complications in prolactinoma patients.
• To evaluate outcomes considering clinical characteristics and disease severity.

Main Methods:

• Review of existing clinical studies and seminal research from the authors' group.
• Analysis of prolactin's direct and indirect effects on bone cells and calcium metabolism.
• Assessment of vertebral fracture prevalence and bone mineral density changes.

Main Results:

• Prolactinomas are associated with an increased prevalence of vertebral fractures (VFs) in both sexes.
• Dopamine agonist treatment for prolactinoma can reverse hypogonadism and enhance bone mineral density.
• Vertebral fractures may indicate more aggressive pituitary adenoma disease.

Conclusions:

• Prolactinomas pose a significant risk to skeletal integrity through multiple mechanisms.
• Management of bone comorbidities requires a multidisciplinary approach within specialized centers.
• Early identification and treatment of skeletal complications are crucial for patient outcomes.