Abstract
There is increasing use of antipsychotic drugs in pediatric and psychiatry practice for a wide range of behavioral and affective disorders. These drugs have prominent side effects of interest to pediatric endocrinologists, including weight gain and associated metabolic risk factors and hyperprolactinemia. The drugs block dopamine action, thus disinhibiting prolactin secretion. Hyperprolactinemia is especially prominent with first-generation antipsychotics such as haloperidol and the second-generation drugs, most commonly risperidone, with some patients developing gynecomastia or galactorrhea or, as a result of prolactin inhibition of gonadotropin releasing hormone from the hypothalamus, amenorrhea. With concern about the long-term effects of antipsychotics on bone mass and pituitary tumor formation, it is prudent to monitor serum prolactin levels in antipsychotic drug-treated pediatric patients and consider treatment with an agent less likely to induce hyperprolactinemia.
Highlights
The practice of psychiatry and the shift to noninstitutional care of severe psychiatric disorders are the result of antipsychotic medications, beginning with chlorpromazine in the early 1950s
Three adolescents were reported with risperidoneinduced hyperprolactinemia resulting in gynecomastia in one boy that cleared and did not recur with olanzapine, gynecomastia with galactorrhea in another boy with comparable prolactinemia that resolved when he was switched to clozapine, and amenorrhea and galactorrhea in the third patient that resolved when she was changed to quetiapine
Second-generation antipsychotics are being increasingly prescribed for children and adolescents with a wide range of behavioral disturbances in addition to psychoses, resulting in metabolic and hormonal changes of importance to the consulting pediatric endocrinologist
Summary
The practice of psychiatry and the shift to noninstitutional care of severe psychiatric disorders are the result of antipsychotic medications, beginning with chlorpromazine in the early 1950s. 10 other drugs, known as firstgeneration or typical antipsychotics, followed over the subsequent 30 years These drugs were effective in treating positive symptoms of psychosis such as hallucination and delusion but did not alleviate the negative symptoms of withdrawal, apathy, cognitive impairment, or loss of affect. The principal concern for endocrinologists with the newer drugs has been the metabolic effects of weight gain, glucose intolerance, hyperlipidemia, and hypertension [2]. This is important with the increasing use of these agents in pediatrics to treat bipolar disorder, schizophrenia, autism, oppositional and other behavior disturbances, Tourette disorder, and pervasive developmental disorder. This paper will examine the side effect of hyperprolactinemia in children and adolescents treated with antipsychotic drugs
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