Abstract：
BACKGROUND: Prolactin (PRL) is a crucial mediator of gluco-insulinemic metabolism.
OBJECTIVE: Dissecting glucose metabolism during and after pregnancy in patients with prolactinomas.
METHODS: 52 patients treated with cabergoline (CAB) were evaluated before conception, during pregnancy and up to 10 years after delivery. During pregnancy, CAB was discontinued, while it was restarted in 57.7 % of patients after delivery, due to recurrent hyperprolactinemia (RH). Hormonal (serum PRL) and metabolic (HbA1c, fasting glucose/FG, glucose tolerance) parameters were assessed.
RESULTS: During pregnancy, PRL gradually increased, while FG remained stable. An inverse correlation between PRL and FG was found in the first (p=0.032) and third (p=0.048) trimester. PRL percent increase across pregnancy was inversely correlated with third trimester FG. Serum PRL before conception emerged as predictive biomarker of third trimester FG (τ=2.603; p=0.048). Elderly patients with lower HbA1c at first trimester and lower FG at 3 years postpartum, delivered infants with reduced birth weight. Breastfeeding up to 6 months correlated with lower FG at 4 and 10 years postpartum. A positive correlation between BMI and FG at 10 years after delivery (p=0.03) was observed, particularly in overweight/obese patients requiring higher CAB doses. Patients with RH who had to restart CAB showed shorter breastfeeding duration and higher FG at 2 years postpartum.
CONCLUSIONS: Low PRL levels before pregnancy may be detrimental to FG during pregnancy. CAB duration and dose may influence long-term glucose tolerance, besides family history and BMI. Pre-conceptional metabolic management should be recommended to reduce the risk of gestational and type 2 diabetes mellitus.
OBJECTIVE: Dissecting glucose metabolism during and after pregnancy in patients with prolactinomas.
METHODS: 52 patients treated with cabergoline (CAB) were evaluated before conception, during pregnancy and up to 10 years after delivery. During pregnancy, CAB was discontinued, while it was restarted in 57.7 % of patients after delivery, due to recurrent hyperprolactinemia (RH). Hormonal (serum PRL) and metabolic (HbA1c, fasting glucose/FG, glucose tolerance) parameters were assessed.
RESULTS: During pregnancy, PRL gradually increased, while FG remained stable. An inverse correlation between PRL and FG was found in the first (p=0.032) and third (p=0.048) trimester. PRL percent increase across pregnancy was inversely correlated with third trimester FG. Serum PRL before conception emerged as predictive biomarker of third trimester FG (τ=2.603; p=0.048). Elderly patients with lower HbA1c at first trimester and lower FG at 3 years postpartum, delivered infants with reduced birth weight. Breastfeeding up to 6 months correlated with lower FG at 4 and 10 years postpartum. A positive correlation between BMI and FG at 10 years after delivery (p=0.03) was observed, particularly in overweight/obese patients requiring higher CAB doses. Patients with RH who had to restart CAB showed shorter breastfeeding duration and higher FG at 2 years postpartum.
CONCLUSIONS: Low PRL levels before pregnancy may be detrimental to FG during pregnancy. CAB duration and dose may influence long-term glucose tolerance, besides family history and BMI. Pre-conceptional metabolic management should be recommended to reduce the risk of gestational and type 2 diabetes mellitus.
摘要：
背景：催乳素（PRL）是葡萄糖-胰岛素代谢的关键介质。
目的：剖析泌乳素腺瘤患者妊娠期间和妊娠后的糖代谢。
方法：52例接受卡麦角林（CAB）治疗的患者在受孕前进行评估，在怀孕期间和分娩后长达10年。在怀孕期间,CAB停产了,虽然57.7%的患者在分娩后重新启动，由于复发性高泌乳素血症（RH）。激素（血清PRL）和代谢（HbA1c，空腹血糖/FG，糖耐量）参数进行了评估。
结果：在怀孕期间，PRL逐渐增加，而FG保持稳定。在前三个月（p=0.032）和第三个三个月（p=0.048）中发现PRL和FG之间的负相关。整个怀孕期间PRL百分比的增加与妊娠晚期FG呈负相关。受孕前血清PRL作为妊娠晚期FG的预测生物标志物(τ=2.603;p=0.048)。妊娠早期HbA1c较低，产后3年FG较低的老年患者，出生体重减轻的婴儿。母乳喂养长达6个月与产后4年和10年FG降低相关。在分娩后10年观察到BMI和FG之间的正相关（p=0.03），特别是在需要更高CAB剂量的超重/肥胖患者中。必须重新开始CAB的RH患者在产后2年表现出更短的母乳喂养持续时间和更高的FG。
结论：怀孕前低PRL水平可能对怀孕期间的FG有害。CAB持续时间和剂量可能会影响长期葡萄糖耐量，除了家族史和BMI。应建议进行孕前代谢管理，以降低妊娠和2型糖尿病的风险。
目的：剖析泌乳素腺瘤患者妊娠期间和妊娠后的糖代谢。
方法：52例接受卡麦角林（CAB）治疗的患者在受孕前进行评估，在怀孕期间和分娩后长达10年。在怀孕期间,CAB停产了,虽然57.7%的患者在分娩后重新启动，由于复发性高泌乳素血症（RH）。激素（血清PRL）和代谢（HbA1c，空腹血糖/FG，糖耐量）参数进行了评估。
结果：在怀孕期间，PRL逐渐增加，而FG保持稳定。在前三个月（p=0.032）和第三个三个月（p=0.048）中发现PRL和FG之间的负相关。整个怀孕期间PRL百分比的增加与妊娠晚期FG呈负相关。受孕前血清PRL作为妊娠晚期FG的预测生物标志物(τ=2.603;p=0.048)。妊娠早期HbA1c较低，产后3年FG较低的老年患者，出生体重减轻的婴儿。母乳喂养长达6个月与产后4年和10年FG降低相关。在分娩后10年观察到BMI和FG之间的正相关（p=0.03），特别是在需要更高CAB剂量的超重/肥胖患者中。必须重新开始CAB的RH患者在产后2年表现出更短的母乳喂养持续时间和更高的FG。
结论：怀孕前低PRL水平可能对怀孕期间的FG有害。CAB持续时间和剂量可能会影响长期葡萄糖耐量，除了家族史和BMI。应建议进行孕前代谢管理，以降低妊娠和2型糖尿病的风险。
