Dopaminergic tone and obesity: an insight from prolactinomas treated with bromocriptine

Objective: It has recently been shown that increased body weight is associated with prolactinomas and that weight loss occurs with normalization of prolactin levels. On the other hand, decreased dopaminergic tone in humans is well correlated with obesity. The objective of this study was to correlate changes in prolactin levels with leptin and body mass index (BMI) in patients with prolactinomas treated with the long-acting dopamine agonist bromocriptine (BC). Methods: Eleven female and twelve male patients, aged 36.7+/-2.6 years with BMI in males of 30.4+/-1.7 kg/m(2) and in females of 24.4+/-1.2 kg/m(2), were evaluated after I and 6 months and 11 patients were further evaluated after 2 years of BC therapy. Plasma prolactin is presented as the mean of four samples taken daily. Serum leptin was determined in the pooled serum from three samples taken at 15-min intervals at 0800 h after an overnight fast. Multivariate linear regression and repeated measures analysis of covariance were used. Results: In males, pretreatment prolactin levels were 71 362+/-29 912 mU/l while leptin levels were 14.9+/-1.8mug/l. In females, pretreatment prolactin levels were 11 395+/-5839 mU/l and leptin levels were 16.7+/-2.5 mug/l. The sexual dimorphism of serum leptin levels at initial presentation was preserved after adjusting for BMI and prolactin-induced hypogonadism. After I month of therapy, prolactin levels significantly decreased (males: 17618+/-8736 mU/l, females: 3686 2231; P < 0.05), BMI did not change (males: 30.2+/-1.7 kg/m(2), females: 24.1+/-1.2 kg/m(2); P > 0.05), while serum leptin levels decreased (males: 12.5+/-1.5 mug/l, females: 13.6+/-2.1 mug/l; P < 0. 0 5). After 6 months of treatment, prolactin further decreased (males: 3456+/-210 mU/l, females: 677+/-360 mU/l; P<0.05) as did BMI (males: 28.6+/-1.6 kg/m(2), females 23.1+/-1.0 kg/m(2); P < 0.05). The difference was more pronounced in male patients. Leptin levels were 12.8+/-2.8 mug/l in males and 12.9+/-1.8 mug/l in females (P < 0.05). After 2 years of BC treatment, prolactin levels were near normal (males: 665 439 mU/l, females 447+/-30mU/l; P < 0.05) and BMI remained 26.5+/-1.9 kg/m(2) for males and 23.6+/-0.8 kg/m(2) for females (P < 0.05). Leptin levels were 9.5+/-2.2 mug/l in males and 18.7+/-3.1 mug/l in females (P < 0.05). There was a gradual increase in the gender difference in serum leptin levels over time. Changes in serum leptin levels significantly correlated with changes in BMI (r = 0.844, P < 0.001) but did not correlate with changes in plasma prolactin levels after 1 month (r = 0.166), 6 months (r = 0.313) and 2 years (r = 0.234, P > 0.05). Conclusion: The long-acting dopamine agonist BC, by increasing dopaminergic tone, may influence body weight and likely body composition by mechanisms in addition to reducing hyperprolactinemia in patients with prolactinomas.