Vera-Lastra Olga, Jara Luis J, Medina Gabriela, Rojas Juan L, Veláquez Francisco, Ariza Raul, Normandía Asunciòn, Fuentes Margarita
Department of Internal Medicine, Division of Research, Clinical and Epidemiology Research, Office of Education Research, Hospital de Espcialidades, Centro Medico La Raza, IMSS, Mexico City, Mexico.
J Rheumatol. 2006 Jun;33(6):1108-12. Epub 2006 May 15.
Hyperprolactinemia (HPRL) has been identified in more than half of patients with systemic sclerosis (SSc). However, the association with pituitary adenoma and the status of hypothalamic dopaminergic tone using metoclopramide (MTC) test has not been studied. We investigated the prevalence of prolactin (PRL)-secreting pituitary adenoma and evaluated production of PRL by dynamic testing with MTC in SSc.
We studied 30 patients with SSc (mean age 38 +/- 10 yrs) and 20 healthy controls (mean age 37 +/- 11 yrs). Serum PRL concentrations were determined by radioimmunoassay in all subjects, and PRL response was measured 30, 60, 90, and 120 min after injection of 10 mg of MTC. Computed tomography (CT) of the sella turcica was performed.
The mean basal serum PRL levels before and after stimulation with MTC in SSc patients versus controls were: basal 18.2 +/- 5.4 versus 8.7 +/- 1.6 ng/ml, p = NS; 30 min: 175.0 +/- 5.4 versus 61.0 +/- 42 ng/ml, p < 0.001; 60 min: 160 +/- 64 versus 52 +/- 30 ng/ml, p < 0.001; 90 min: 125 +/- 57 versus 42 +/- 21.0 ng/ml, p < 0.05; 120 min: 108.0 +/- 57 versus 30.0 +/- 10 ng/ml, p < 0.005. CT scan showed microadenomas in 24/30 SSc patients and 1/20 controls (p = 0.001).
Our study suggests that a group of patients with SSc have a high prevalence of HPRL with increased central dopaminergic tone, and microadenomas. PRL may have a role in the pathogenesis of SSc. Further studies are necessary to confirm our results.
在超过半数的系统性硬化症（SSc）患者中发现了高催乳素血症（HPRL）。然而，尚未研究其与垂体腺瘤的关联以及使用甲氧氯普胺（MTC）试验评估下丘脑多巴胺能张力状态。我们调查了分泌催乳素（PRL）的垂体腺瘤的患病率，并通过MTC动态试验评估了SSc患者PRL的分泌情况。
我们研究了30例SSc患者（平均年龄38±10岁）和20例健康对照者（平均年龄37±11岁）。通过放射免疫分析法测定所有受试者的血清PRL浓度，并在注射10mg MTC后30、60、90和120分钟测量PRL反应。进行了蝶鞍计算机断层扫描（CT）。
SSc患者与对照者在MTC刺激前后的平均基础血清PRL水平分别为：基础值18.2±5.4对8.7±1.6ng/ml，p =无显著性差异；30分钟时：175.0±5.4对61.0±42ng/ml，p<0.001；60分钟时：160±64对52±30ng/ml，p<0.001；90分钟时：125±57对42±21.0ng/ml，p<0.05；120分钟时：108.0±57对30.0±10ng/ml，p<0.005。CT扫描显示24/30例SSc患者有微腺瘤，1/20例对照者有微腺瘤（p = 0.001）。
我们的研究表明，一组SSc患者HPRL患病率高，伴有中枢多巴胺能张力增加和微腺瘤。PRL可能在SSc的发病机制中起作用。需要进一步研究来证实我们的结果。
