PMC6333117_01
Clinical timeline. Prolactin concentrations are shown through the last 15 years. Blue boxes represent hyperprolactinemia-related symptoms. Red boxes represent autoimmune manifestations. Yellow boxes show treatments. Green box indicates the time NMR was done. APS, antiphospholipid syndrome; NMR, nuclear magnetic resonance; SLE, systemic lupus erythematosus; SS, Sjogren's syndrome
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This clinical picture was associated with PRL levels between 20 and 40 ng/mL (Figure 1), despite cabergoline treatment at 0.5 mg twice per week. In 2007, amenorrhea recurred due to high levels of PRL; therefore, bromocriptine was restarted (Figure 1). In 2015, when lower PRL levels were reached, new onset of Raynaud's phenomenon, sicca symptoms, alopecia, and unintentional weight loss were identified (Figure 1).
Proband pedigree. Specific autoimmune diseases are in colors. The pedigree discloses both polyautoimmunity (ie, two or more autoimmune diseases in a single patient) and familial autoimmunity (ie, diverse autoimmune diseases in a nuclear family). One patient's cousin suffers from prolactinoma and SLE
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Interestingly, she presented with familial autoimmunity and one relative with SLE associated with prolactinoma (Figure 2).
(A) Minor salivary gland biopsy, 40x. Arrows: lymphocytic infiltration. Arrowheads: Salivary acinus. (B) Sella turcica nuclear magnetic resonance. Green arrow: asymmetry of pituitary gland due to pharmacology treatment with cabergoline and bromocriptine
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The minor salivary gland biopsy showed a focus score >1 (Figure 3A), and the sella turcica nuclear magnetic resonance (STNMR) disclosed pituitary asymmetry (Figure 3B).