A. Bachelot

Reproductive role of prolactin

The biological actions of prolactin (PRL), a polypeptide hormone, are mostly related to lactation and reproduction. These actions have been clarified by studies of PRL and PRL-deficient receptor mice, which have a clear phenotype of reproductive failure at multiple sites. This review aims to summarize current knowledge about PRL and its receptor, role in reproductive axis and presents information of hyperprolactinemia in reproductive medicine. Our understanding of the physiology and transduction pathway of PRL has largely increased in the past 20 years with the cloning of PRL and its receptor gene.

Impact of total cumulative glucocorticoid dose on bone mineral density in patients with 21-hydroxylase deficiency

OBJECTIVE It remains controversial whether long-term glucocorticoids are charged of bone demineralization in patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The aim of this study was to know whether cumulative glucocorticoid dose from the diagnosis in childhood to adulthood in patients with CAH had a negative impact on bone mineral density (BMD). DESIGN This was a retrospective study. METHODS Thirty-eight adult patients with classical and non-classical CAH were included. BMD was measured in the lumbar spine and femoral neck. Total cumulative glucocorticoid (TCG) and total average glucocorticoid (TAG) doses were calculated from pediatric and adult files. RESULTS We showed a difference between final and target heights (-0.82+/-0.92 s.d. for women and -1.31+/-0.84 s.d. for men; P<0.001). Seventeen patients (44.7%) had bone demineralization (35.7% of women and 70% of men). The 28 women had higher BMD than the 10 men for lumbar (-0.26+/-1.20 vs -1.25+/-1.33 s.d.; P=0.02) and femoral T-scores (0.21+/-1.30 s.d. versus -1.08+/-1.10 s.d.; P=0.007). In the salt-wasting group, women were almost significantly endowed with a better BMD than men (P=0.053). We found negative effects of TCG, TAG on lumbar (P<0.001, P=0.002) and femoral T-scores (P=0.006, P<0.001), predominantly during puberty. BMI was protective on BMD (P=0.006). CONCLUSION The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. The glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.

Quand et comment traiter une hyperprolactinémie

Points essentials • L’hyperprolactinemie a un retentissement sur l’axe gonadotrope. • L’amenorrhee, les troubles du cycle et la galactorrhee predominent chez la femme, tandis que, chez l’homme, du fait de la frequence de macroadenomes a prolactine, les troubles de la libido ou en rapport avec le volume tumoral au niveau hypophysaire sont souvent au premier plan. • Le dosage radio-immunologique rend aise le diagnostic des hyperprolactinemies. • Il est necessaire d’eliminer les causes secondaires, en particulier medicamenteuses, d’hyperprolactinemie avant de poursuivre les explorations a la recherche d’une tumeur hypophysaire par IRM. • Le traitement de premiere intention des adenomes a prolactine repose sur l’utilisation d’agonistes dopaminergiques, en particulier de la cabergoline, du fait de leur tres bonne efficacite et des risques de recidive apres chirurgie. • Pour une patiente ayant un desir de grossesse, il faut continuer l’agoniste dopaminergique pendant la grossesse en cas de macroadenome mais l’arreter en cas de microadenome. • Le traitement des hyperprolactinemies induites par les traitements antipsychotiques necessiterait une evaluation plus poussee.