Can exposure to diesel fuel, Jet Propulsion 8 (JP8), Jet Propulsion 4 (JP-4), industrial solvents for cleaning grease, hydraulic fluid, oil, and exhaust fumes cause prolactinoma and hyperprolactinemia?

From the Guidelines

There is no established direct causal link between exposure to diesel fuel, JP8, JP-4, industrial solvents, hydraulic fluid, oil, or exhaust fumes and the development of prolactinoma or hyperprolactinemia, as evidenced by the lack of conclusive scientific literature on this topic 1. Prolactinoma is a benign tumor of the pituitary gland that produces excess prolactin hormone, while hyperprolactinemia is the condition of having elevated prolactin levels in the blood. These conditions are typically caused by factors such as pituitary tumors, certain medications (particularly antipsychotics, some antidepressants, and anti-nausea drugs), hypothyroidism, kidney disease, or chest wall injuries. Some key points to consider in the diagnosis and management of prolactinomas include:

• The use of cabergoline as first-line therapy for prolactinomas, even in the presence of visual disturbance and pituitary apoplexy, while carefully monitoring for any deterioration in vision, pituitary function, or general status 1.
• The consideration of radiotherapy if surgery is not an option, with the main indication for radiotherapy being control of tumor growth, whereas normalization of prolactin levels is a secondary objective 1.
• The importance of monitoring clinical and biochemical parameters, including serum prolactin levels, and performing regular imaging studies, such as MRI, to assess tumor size and response to treatment 1.
• The potential for medication-induced hyperprolactinemia, which can be caused by various medications, including antipsychotics, antidepressants, and anti-nausea drugs, and the need to exclude confounding diseases, such as primary hypothyroidism, chronic kidney disease, and severe liver disease 1. If you're experiencing symptoms of hyperprolactinemia (such as irregular periods, galactorrhea, erectile dysfunction, or reduced libido) and have a history of chemical exposure, it's essential to consult with an endocrinologist who can properly evaluate your condition through blood tests and possibly imaging studies like MRI to determine the actual cause and appropriate treatment.

From the Research

Causes of Hyperprolactinemia and Prolactinoma

• Hyperprolactinemia is characterized by increased production of prolactin, often leading to reproductive dysfunction and galactorrhea 2
• Prolactinomas are the most common pituitary tumors and may cause male-factor infertility by producing hypogonadism 2
• The diagnostic evaluation of hyperprolactinemia requires exclusion of other causes, such as pregnancy, primary hypothyroidism, numerous medications, and miscellaneous causes 2

Treatment of Hyperprolactinemia and Prolactinoma

• The treatment of choice for nearly all patients with hyperprolactinemic disorders is medical, using dopamine agonists such as bromocriptine, pergolide, and cabergoline 2, 3
• Cabergoline is the preferred treatment for micro- and macroprolactinomas due to its effectiveness in normalizing prolactin levels and reducing prolactinoma size, as well as its fewer side-effects compared to bromocriptine 4, 5

Exposure to Diesel Fuel, JP8, JP-4, Industrial Solvents, and Exhaust Fumes

• There is no direct evidence in the provided studies to suggest that exposure to diesel fuel, JP8, JP-4, industrial solvents, hydraulic fluid, oil, and exhaust fumes can cause prolactinoma and hyperprolactinemia 2, 3, 4, 6, 5
• The studies focus on the diagnosis, treatment, and management of hyperprolactinemia and prolactinoma, but do not discuss the potential effects of environmental or occupational exposures on these conditions.