Online ISSN: 2515-8260

Infertility predictors for prolactin-secreting pituitary adenomas

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Kh.K Nasirova, Z.Yu. Khalimova, Yu. M. Urmanova, G.D. Narimova


Abstract: Purpose of research - To improve reproductive outcomes of women with prolactinomas by evaluating fertility predictors. Material and methods. We examined 250 women aged 17-35 years (average age 30.5 years) with endocrine infertility (EI) and hyperprolactinemia. Of these, 71 (28.4%) patients with prolactinoma and endocrine infertility were selected for an in-depth study. All patients underwent a complete clinical - hormonal and visualization examination and were divided into patients with EI with pituitary microprolactinomas (64.7%) and patients with EI with macroprolactinomas (35.2%). Clinical, imaging, and hormonal studies have been performed. The basal levels of the pituitary gonadotropic hormones — LH, FSH, as well as PRL, TH, peripheral gland hormones cortisol (C), estradiol (E) and total testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), progesterone, inhibins A and B were determined , activin, antimuller hormone. The research materials were subjected to statistical processing using the methods of parametric and non-parametric analysis. Results. According to the objectives, the functional state of the HPO system and the clinical characteristics of infertility in prolactinomas were studied, an analysis of complaints and anamnestic data of patients with EI with prolactinomas was made, depending on the size of the formation in a comparative aspect. The state of ovarian reserve was assessed, with the determination of FSH, activin, AMH, inhibin A and B in the blood serum. The inhibin A level in both Me groups was 1.30 ng/ml, which significantly differed from the control group (p₂ ˂0.0001, p₃ ˂0.0001). The level of inhibin B underwent significant changes in both groups. A decrease in inhibin B and an increase in FSH can prove a decrease in ovulatory ovarian reserve. The studied women with EI in both groups showed a decrease in AMH, in the group with microadenomas ranged from 0.12 to 2.1 and averaged 0.75 ± 0.27 ng/ml, and in the group with macroadenomas ranged from 0.09-2.2 and averaged 0.97 ± 0.49 ng/ml, which significantly differed from the control group (p₁ ˂0.05, p₂ ˂0.001 p₃ ˂0.001). The conducted Spearman correlation and regression analysis showed that between prolactin and AMH (r = -0.4; p˂0.01), between prolactin and progesterone (21dMC) (r = -0.576; p˂0.0001) as well as between prolactin and inhibin B (r = -0.67) there is a strong “-“ negative relationship and all indicators were statistically significant. Conclusions: Endocrine disorders in women with prolactinomas are significantly increased in patients with macroadenoma compared with microadenoma. Correlation-regression analysis found a negative relationship between PRL and AMH (r = -0.4, P <0.0001), PRL and progesterone (r = -0.57, P <0.0001). With an increase in PRL by 1 unit, there is a decrease in AMH by 0.008 units (P <0.001), a decrease in inhibin B by 0.11 (P <0.001), progesterone by 0.04 units (P <0.0001) and the degree of hyperprolactinemia and this all can predict EI development.

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