ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12669ometendo-12669Research ArticleСлучай из практикиCase ReportСложности в диагностике аденом со смешанной секрецией соматотропного гормона и пролактинаDifficulties in diagnosis of adenomas with mixed prolactin and growth hormone secretion: case presentationДзерановаЛариса КонстантиновнаDzeranovaLarisa K.

Дзеранова Лариса Константиновна, д.м.н., ORCID: https://orcid.org/0000-0002-0327-4619, eLibrary SPIN: 2958-5555, e-mail: dzeranovalk@yandex.ru

Larisa K. Dzeranova, MD, PhD, ORCID: https://orcid.org/0000-0002-0327-4619, eLibrary SPIN: 2958-5555, e-mail: dzeranovalk@yandex.ru

dzeranovalk@yandex.ruАбойшеваЕлизавета АндреевнаAboishavaLizaveta A.

Абойшева Елизавета Андреевна, ординатор, ORCID: https://orcid.org/0000-0002-0306-6588, eLibrary SPIN 3828-3502, e-mail: lizaveta.aboisheva@gmail.com.

117036, Москва, ул. Дм. Ульянова, д. 11

Lizaveta A. Aboishava, resident, ORCID: https://orcid.org/0000-0002-0306-6588; eLibrary SPIN 3828-3502; e-mail: lizaveta.aboisheva@gmail.com.

11 Dm.Ulyanova street, 117036 Moscow

lizaveta.aboisheva@gmail.comФедороваНаталья СергеевнаFedorovaNatalya S.

Федорова Наталья Сергеевна, к.м.н., ORCID: https://orcid.org/0000-0002-9816-5043, eLibrarySPIN: 6599-5612, e-mail: fedorova.n.s.12@gmail.com

Natalya S. Fedorova, MD, PhD, ORCID: https://orcid.org/0000-0002-9816-5043;eLibrary SPIN: 6599-5612; e-mail: fedorova.n.s.12@gmail.com

fedorova.n.s.12@gmail.comВоротниковаСветлана ЮрьевнаVorotnikovaSvetlana Y.

Воротникова Светлана Юрьевна, ORCID: https://orcid.org/0000-0001-7470-1676, eLibrary SPIN: 6571-1206, e-mail: bra_svetix@list.ru

Svetlana Y. Vorotnikova, MD ORCID: https://orcid.org/0000-0001-7470-1676; eLibrary SPIN: 6571-1206; e-mail: bra_svetix@list.ru

bra_svetix@list.ruПигароваЕкатерина АлександровнаPigarovaEkaterina A.

Пигарова Екатерина Александровна, д.м.н., ORCID: https://orcid.org/0000-0001-6539-466X, eLibrary SPIN: 6912-6331, e-mail: kpigarova@gmail.com

Ekaterina A. Pigarova, MD, PhD, ORCID: https://orcid.org/0000-0001-6539-466X; eLibrary SPIN: 6912-6331; e-mail: kpigarova@gmail.com

kpigarova@gmail.comЛапшинаАнастасия МихайловнаLapshinaAnastasiya M.

Лапшина Анастасия Михайловна, к.м.н., ORCID: https://orcid.org/0000-0003-4353-6705, eLibrary SPIN: 1582-5033, email: nottoforget@yandex.ru

Anastasiya M. Lapshina, MD, PhD;ORCID: https://orcid.org/0000-0003-4353-6705; eLibrary SPIN: 1582-5033; email: nottoforget@yandex.ru

nottoforget@yandex.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology research centreRussian Federation202004122020173233240Copyright © Дзеранова Л.К., Абойшева Е.А., Федорова Н.С., Воротникова С.Ю., Пигарова Е.А., Лапшина А.М., 20202020Дзеранова Л.К., Абойшева Е.А., Федорова Н.С., Воротникова С.Ю., Пигарова Е.А., Лапшина А.М.Dzeranova L.K., Aboishava L.A., Fedorova N.S., Vorotnikova S.Y., Pigarova E.A., Lapshina A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12669

Гиперпролактинемия — стойкое избыточное содержание пролактина в сыворотке крови. Возникающий на фоне гиперпролактинемии симптомокомплекс в первую очередь, заключается в нарушении функции репродуктивной системы. Секреция пролактина находится под сложным нейроэндокринным контролем, в котором участвуют различные по своей природе факторы: нейромедиаторы, гормоны периферических эндокринных желез. В большей мере пролактин изолированно синтезируется и секретируется клетками гипофиза — лактотропами, но в ряде случаев гиперсекреция пролактина сочетается с избыточной продукцией гормона роста, что характерно для опухолей, исходящих из линии клеток-предшественников лактотропов и соматотропов гипофиза, маммосоматотропов. В этом случае симптомокомплекс гиперпролактинемии сопровождается клиническими проявлениями акромегалии. У пациентов с акромегалией возможно развитие гиперпролактинемии как вследствие компрессии ножки гипофиза, так и при смешанной секреции пролактина и соматотропного гормона клетками аденомы. Совместная дифференцировка лактотропных и соматотропных клеток гипофиза под влиянием фактора транскрипции Pit-1 определяет тесную связь этих клеточных линий и, наиболее вероятно, является одной из причин образования аденом со смешанной секрецией. В литературе описаны случаи отсроченной инициации секреции соматотропного гормона у пациентов с ранее диагностированными пролактиномами.

Клинические проявления гиперпролактинемии могут стать причиной обращения пациентов к врачу до развития внешних изменений, характерных для акромегалии. Необходимо внимательное отношение как к первичной диагностике, так и к клиническому течению заболевания у пациентов с гиперпролактинемией и аденомой гипофиза: при первичном обследовании необходимо провести полноценную оценку гормонального статуса с обязательным исследованием инсулиноподобного фактора роста 1 (ИФР-1), при дальнейшем наблюдении пациента целесообразно рассмотреть не только оценку снижения уровня пролактина и уменьшения размеров аденомы при лечении агонистами дофаминовых рецепторов, но и периодическое определение уровня ИФР-1. Аденомы гипофиза со смешанной секрецией соматотропного гормона и пролактина могут характеризоваться более неблагоприятным прогнозом.

Hyperpolactinemia is a persistent excess of prolactin in the blood serum. The symptom complex of hyperprolactinemia primarily consists of disturbances in function of the reproductive system. The secretion of prolactin is under complex neuroendocrine control, which involves factors of different nature: neurotransmitters, hormones of the peripheral endocrine glands. In most cases, prolactin is secreted by pituitary cells - lactotrophs, but in some cases, hypersecretion of prolactin is combined with an excess production of growth hormone, which is typical for tumors originating from the line of progenitor cells of lactotrophs and somatotrophs of the pituitary gland, mammosomatotrophs. In this case, the symptom complex of hyperprolactinemia is accompanied by clinical manifestations of acromegaly. In patients with acromegaly, the cause of hyperprolactinemia may be pituitary stalk compression or mixed secretion of prolactin and growth hormone. Differentiation of lactotropic and somatotropic pituitary cells is determined by transcription factor Pit-1. These cell lineages are closely connected,  and this may be one of the reasons for formation of tumors with mixed secretion. Reports of late presentation of acromegaly in patients previously diagnosed with prolactinomas have also been described in literature.

Clinical manifestations of hyperprolactinemia can cause the patient to seek doctor’s attention before acromegalic changes in appearance develop. Careful attention is needed both to the primary diagnosis and to the clinical course of the disease in patients with hyperprolactinemia and pituitary adenoma: full assessment of hormonal status with mandatory evaluation of IGF-1 is crucial at initial examination, during further observation it may be advised to consider periodic evaluation of IGF-1 in addition to assessment of prolactin and the size of adenoma.  Pituitary adenomas with mixed secretion may have a poorer prognosis.

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The authors declare that there are no conflicts of interest present.