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Importance of Gonadal Steroids to Bone Mass in Men with Hyperprolactinemic Hypogonadism

Susan L. Greenspan, MD; Daniel S. Oppenheim, MD, PhD; and Anne Klibanski, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by grants NIA Physician Scientist Award K12AG00294, HD-21204, and RR-01066 from the National Institutes of Health.

Requests for Reprints: Anne Klibanski, MD, Neuroendocrine ACC-630, Massachusetts General Hospital, Boston, MA 02114.

Current Author Addresses: Dr. Greenspan: Department of Medicine, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215. Drs. Oppenheim and Klibanski: Department of Medicine, Massachusetts General Hospital, Fruit Street, Boston, MA 02114.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(7):526-531. doi:10.7326/0003-4819-110-7-526
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Study Objective: To determine the effects of alteration of gonadal steroids on bone mass in men with hyperprolactinemic hypogonadism.

Design: Prospective survey of patients for a median period of 33 months.

Setting: Neuroendocrine clinical center of a referral-based university medical center.

Interventions: Reversal of hyperprolactinemia by bromocriptine therapy, transsphenoidal surgery, or radiation therapy, alone or in combination.

Patients: Consecutive sample of 20 male patients with prolactin-secreting pituitary tumors.

Measurements and Main Results: In patients who had a reversal of hyperprolactinemia and a restoration of gonadal function, a significant increase in bone density of the radial shaft was noted (mean ± SE, 0.77 ± 0.03 to 0.84 ± 0.03 g/ cm2; P ≤ 0.05). These patients also had a minimal change in the density of vertebral bone (109 ± 9 to 115 ± 10 mg of potassium phosphate, dibasic/cm3). Patients who remained hypogonadal despite the reversal of hyperprolactinemia had no change in radial (0.76 ± 0.03 to 0.76 ± 0.04 g/cm2) or vertebral bone density (105 ± 10 to 103 ± 9 mg of potassium phosphate, dibasic/cm3). There was a positive correlation between the change in testosterone level and the change in radial (r = 0.67, P ≤ 0.003) or vertebral bone density (r = 0.70, P ≤ 0.003).

Conclusions: The reversal of hypogonadism, independent of the prolactin concentration, is associated with an improvement in bone mass. Our findings emphasize the importance of gonadal steroids in maintaining skeletal integrity in men.





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