case_images: PMC6333117_01
case_images: 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
case_images: CCR3-7-19-g001.jpg
case_images: PMC6333117_01_CCR3-7-19-g001.jpg
case_images: ccr31900-fig-0001
case_images: 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).
case_images: 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
case_images: CCR3-7-19-g002.jpg
case_images: PMC6333117_01_CCR3-7-19-g002.jpg
case_images: ccr31900-fig-0002
case_images: Interestingly, she presented with familial autoimmunity and one relative with SLE associated with prolactinoma (Figure 2).
case_images: (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
case_images: CCR3-7-19-g003.jpg
case_images: PMC6333117_01_CCR3-7-19-g003.jpg
case_images: ccr31900-fig-0003
case_images: 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).