Functional hyperprolactinemia and hypophyseal microadenoma in systemic sclerosis.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Correlation of prolactin serum concentrations with clinical activity and remission in patients with systemic lupus erythematosus. Effect of conventional treatment.

OBJECTIVE: The role of prolactin (PRL) in the pathogenesis of systemic lupus erythematosus (SLE) is controversial. The effect of conventional treatment (steroids, antimalarials, immunosuppressor drugs) on PRL concentrations is unclear. We investigated correlation of PRL levels with lupus activity in patients at entry and after 6 months of conventional treatment. METHODS: We studied 43 female patients with active SLE, who were divided in 2 groups; Group 1: 16 patients with minor organ involvement (cutaneous and articular involvement), and Group 2: 27 patients with major organ involvement (glomerulonephritis). Controls were 36 healthy individuals. PRL levels were determined by an immunoradiometric assay at entry and after 6 months of treatment. PRL levels were correlated with SLE Disease Activity Index (SLEDAI) score. RESULTS: Mild hyperprolactinemia (HPRL, 20-40 ng/ml) was found in 30/43 (69.7%) SLE patients. After 6 months of treatment a reduction in PRL levels was found in both groups: Group 1: 24.3 +/- 10.8 to 16.96 +/- 10.87 ng/ml (p < 0.001); and Group 2: 23.6 +/- 5.7 to 12.07 +/- 11.13 ng/ml (p < 0.001). The SLEDAI score also decreased after treatment: Group 1: 16.5 +/- 5.9 to 2.1 +/- 1.3 (p < 0.001); Group 2: 16.8 +/- 5.4 to 1.6 +/- 1.4 (p < 0.001). At entry and after treatment, a significant correlation between PRL levels and SLEDAI score was found in all patients (r = 0.4946, p = 0.0007, and r = 0.9086, p = 0.0001, respectively). CONCLUSION: HPRL was associated with SLE disease activity. Conventional immunosuppressive therapy decreased PRL levels in direct correlation with decreased SLE activity. This finding emphasizes that PRL may play a role in the pathogenesis and clinical expression of SLE.

Enfermedad por adyuvantes en humanos asociada a la aplicación de sustancias oleosas. Análisis de 30 pacientes / Human adjuvant diseaseassociated to the application of oil substances. Analysis of 30 patients

Objetivo: informar las manifestaciones clínicas y serológicas de pacientes con enfermedad por adyuvantes (EAH). Métodos: se analizaron los datos clínicos y serológicos de pacientes con enfermedad por adyuvantes que fueron atendidos de enero de 1993 a diciembre de 1996 en el departamento de Medicina Interna del Hospital de Especialidades del Centro Médico Nacional La Raza. Se investigaron las sustancias aplicadas, las manifestaciones clínicas, las alteraciones de laboratorio detectadas, la evolución de los pacientes y el tratamiento recibido. Resultados: se estudió a 30 mujeres con edad promedio de 35 ñ 12 años. En todos los casos existió el antecedente de aplicación de diversos aceites no identificados. Fueron 15 los pacientes que presentaron manifestaciones inespecíficas de enfermedad del tejido conjuntivo. El resto cumplieron con criterios de padecimientos definidos: lupus eritematoso sistémico (5), artritis reumatoide (4), síndrome de sobreposición (2), hepatitis autoinmune (1), tiroiditis autoinmune (1) y colitis ulcerosa crónica inespecífica (1). Se trataron con analg,sicos antiinflamatorios no esteroides, esteroides y en algunos casos antifibróticos e inmunosupresores. Cuando fue posible se extrajo quirúrgicamente el tejido fibronecrótico. La mayoría de los pacientes mejoró con el tratamiento; sin embargo, ninguna se curó y sucedieron tres fallecimientos. Conclusión: la enfermedad por adyuvantes es un padecimiento de alta morbilidad, con respuesta terap,utica parcial y es capaz de provocar la muerte. La enfermedad por adyuvantes debe tenerse presente en pacientes con manifestaciones de enfermedad autoinmune y con el antecedente de aplicación de sustancias oleosas.