Elevated Prolactin Levels Research Articles

Audit of Prolactin Levels Monitoring for Inpatients on Antipsychotics in SABP

AimsTo establish whether our practice is meeting NICE and Maudsley guidelines in establishing baseline prolactin levels in an inpatient set-up before starting treatment with antipsychotic medications with a medium or high-risk of causing hyperprolactinaemia.MethodsData were collected retrospectively from case notes of 127 patients from 9 wards at Surrey and Borders Partnership NHS Foundation Trust (SABP).We reviewed if the baseline prolactin was measured for inpatients before commencing on antipsychotics with medium or high risk of hyperprolactinemia.We reviewed if patients with elevated prolactin levels were assessed and managed appropriately.ResultsSABP is currently achieving 43% in recording serum prolactin levels for inpatients who are on antipsychotics with medium or high-risk of hyperprolactinemia respectively.Inpatient ward 76 patients out of total 127 were on antipsychotics with medium to high-risk of developing hyperprolactinemia.33 patients had their serum prolactin checked bringing the compliance to 43%,2 patients were excluded due to incomplete data bringing the sample size to 31.3 had elevated prolactin. Out of 3 patients,1 patient was managed appropriately with MRI brain, followed by change of antipsychotic medication and repeat prolactin levels. For 1 patient, prolactinlevel was rechecked. Unfortunately, no documentation of assessment of symptoms of hyperprolactinemia was found in all three patients case notes.ConclusionThe trust is falling short of meeting NICE and Maudsley guidelines of monitoring prolactin level. It is possible to introduce a robust system within the Trust so that we are complaint with a NICE and Maudsley prolactin monitoring guidelines.We need to local Trust guidelines for management of hyperprolactinaemia in line with NICE and Maudsley guideline of monitoring prolactin levels.Safety netting advice and leaflets explaining symptoms of hyperprolactinaemia should be provided to all the patients on antipsychotics with medium to high risk of developing hyperprolactinemia.

Paroxetine-induced galactorrhea

IntroductionAntidepressant-induced galactorrhea and increases in prolactin levels have been sporadically reported among SSRI-related side effects.ObjectivesCurrent rapport presents a case of 39 y.o. female who developed several adverse effects on paroxetine - including galactorrhoea - which improved on discontinuation of the drug.MethodsCase discussion of 39-year old woman who was treated with paroxetine for her panic disorder and developed galactorrhoea with hyperprolactinemia that resolved upon discontinuation of the drug. Additionally, authors performed the literature search using PubMed and Embase to review the similar cases and used PDSP Database to assess the latest pharmacodynamic (PD) properties of paroxetine and other SSRI’s.ResultsLiterature review (1966–2020) revealed 24 prior published case reports of SSRI-induced galactorrhea in users of paroxetine (n=4), escitalopram (n=4), sertraline (n=2), citalopram (n=2), fluoxetine (n=3), fluvoxamine (n=2) and other non-assessable reports (n=7). Elevated prolactin levels were mostly observed with paroxetine and escitalopram and rarely with fluoxetine, fluvoxamine and sertraline. PD-assessment showed the highest binding affinity of paroxetine and escitalopram to SERT (kPi = 0.07-0.2 and 0.8-1.1 nmol/L respectively) compared to other SSRI’s, in absence of other relevant PD-propertiesConclusionsIncreasing body of evidence shows that galactorrhea does occur among paroxetine female users. Pharmacodynamic mechanism of action is poorly understood but given the modern insights in relationship in serotonin and dopamine circuits, we suggest that strong SERT inhibitory properties of paroxetine might lead to a tonic suppressive influence on dopamine neurotransmission. This physiological link may explain an increase in prolactin levels through dopamine depletion in the tuberoinfundibular pathway.DisclosureNo significant relationships.

Mild hyperprolactinemia in a couple: What impact on fertility?

Mild-to-moderate hyperprolactinemia is a frequent finding in young women presenting with infertility. Prolactin (PRL) concentration should be determined accurately, whether or not the patient has other symptoms suggestive of excess PRL such as galactorrhea or menstrual cycle disorder. After confirmation of persistent hyperprolactinemia on a second blood sample (avoiding conditions known to raise prolactin) and exclusion of macroprolactinemia, prolactinoma and other identifiable non-tumoral causes of hyperprolactinemia must be ruled out. Mildly elevated PRL levels may cause luteal insufficiency in cycling women and are associated with recurrent miscarriage. Any confirmed hyperprolactinemia should be treated in a woman who wishes or fails to become pregnant. Preference is given to cabergoline at the lowest possible dose that normalizes PRL, restoring fertility in the vast majority of cases.Evidence is much less robust in men, in whom PRL concentrations are less prone to increase and the reproductive system is less sensitive to the negative effects of hyperprolactinemia. Nevertheless, chronic and significant hyperprolactinemia in men may impair fertility or cause infertility (with or without hypogonadism) and must be treated, as in women. However, more clinical studies are clearly needed concerning male reproductive function.The significance of mild but persistent hyperprolactinemia in either member of a couple incidentally discovered during assisted reproductive technology (ART) procedures is unclear, and future evidence-based studies are needed to determine whether normalizing prolactin can improve ART outcome.

Abstract #1165468: Stalk Effect: Cushing’s Disease Mistaken for Prolactinoma

The diagnostic workup for hypercortisolism is not infrequent in clinical practice. Common findings of high cortisol are weight gain, facial plethora, and menstrual irregularity. Here we discuss a distinct presentation of amenorrhea and galactorrhea as an unexpected exhibition of Cushing’s disease. A 35-year-old woman with a history of obesity presented with the chief complaint of infertility. Six months prior, she began to experience amenorrhea, galactorrhea, headaches, excessive sweating, and weight gain. Serum prolactin (PRL) level was found to be mildly elevated at 35.3 ng/mL. Magnetic resonance imaging (MRI) of the brain demonstrated a 11 mm x 9.8 mm x 9.6 mm pituitary macroadenoma. She was started on oral cabergoline 0.5 milligrams twice weekly for prolactinoma treatment, with resolution of all symptoms and return to normal PRL range. Tumor size on repeat MRI was stable. Six months later, she conceived. Cabergoline was stopped. She delivered a healthy infant but developed recurrence of her symptoms, now with diplopia. PRL was elevated at 61.9 ng/mL. Cabergoline was reinitiated. Further labs demonstrated elevated plasma adrenocorticotropic hormone (ACTH) of 121 pg/ml, elevated morning salivary cortisol of 0.217 ug/dL and elevated urinary free cortisol of 142 ug/24 hour. Overnight dexamethasone test showed unsuppressed cortisol. Cushing’s disease was diagnosed. Tumor size was 13 mm x 17 mm x 17 mm prior to surgical resection. Tumor pathology showed corticotroph adenoma. PRL highlighted in just a few scattered tumor cells. Her elevated prolactin levels were ultimately suspected to be due to stalk effect. Approximately 40% of all pituitary adenomas are prolactinomas. Clinical signs and symptoms of hyperprolactinemia include infertility, amenorrhea, and galactorrhea. Mild elevations of prolactin may cause infertility and can be consistent with prolactinoma. Amenorrhea associated with galactorrhea strongly suggests hyperprolactinemia. However, clinicians must note that in the presence of sellar mass and mild hyperprolactinemia, a non-prolactin-secreting mass must first be diagnostically ruled out. Cushing’s disease may present similarly with menstrual irregularities, hyperprolactinemia, and galactorrhea due to stalk effect. This patient demonstrated initial diagnostic uncertainty due to her incomplete workup and rapid clinical response to cabergoline. Her elevations in prolactin and response to cabergoline at the time of her original presentation may substantiate the proposed off-label use of dopamine agonists in non-prolactinoma pituitary tumors.

The prevalence of hyperprolactinaemia in subfertile ovulatory women and its impact on fertility treatment outcome

Subtle hyperprolactinaemia is not an uncommon finding in ovulatory subfertile women. The objective of this study is to evaluate the prevalence of hyperprolactinaemia in subfertile ovulatory and oligo-anovulatory women, and to determine if hyperprolactinaemia influences fertility treatment outcome. All women (n = 1010) who attended the fertility clinic of a UK tertiary hospital during 2015–2019 were included. Out of 804 eligible women analysed, 575 women (71.5%) were ovulatory and 229 (28.5%) were oligo-anovulatory. Prevalence of hyperprolactinaemia was higher in the ovulatory group than in the oligo-anovulatory group (26.8% vs. 14.4%; OR: 2.2; 95% confidence interval (CI): 1.4–3.2). On sub-group analysis, the prevalence of mild, moderate and severe hyperprolactinaemia was 23.0%, 3.7% and 0.2% in ovulatory women and 11.8%, 1.7% and 0.9% in oligo-anovulatory women. Mild hyperprolactinaemia was found to be more prevalent in the ovulatory group (OR: 2.2; 95%CI: 1.4–3.5). Ongoing pregnancy/livebirth rates were similar between hyperprolactinaemic and normoprolactinaemic women (42.8% vs. 46.7%). Hyperprolactinaemia did not have an impact on ongoing pregnancy/livebirth rates in both ovulatory and oligo-anovulatory women (OR:0.8; 95%CI: 0.5–1.1; OR: 1.2; 95%CI: 0.6–2.5, respectively). Hyperprolactinaemia is prevalent among ovulatory women, although most had mildly raised clinically insignificant levels. Elevated prolactin levels in ovulatory women do not seem to impact on pregnancy outcome. Impact Statement What is already known on this subject? Prolactin has been linked to ovulation and fertility. Prolactin testing is not generally recommended for subfertile women with regular menstrual cycles, which is a surrogate marker of ovulation. However, some clinicians, particularly in the general practice, still perform prolactin test as part of baseline endocrine profile. What do the results of this study add? Prevalence of hyperprolactinaemia in subfertile ovulatory women was 26.8% (154/575), of which 86% (132/154) were mild. Further, the livebirth/ongoing pregnancy rates were similar between hyperprolactinaemic and normoprolactinaemic women. Prolactin being a sensitive hormone, responsive to even minimal stress and its high levels not influencing clinical pregnancy outcome, prolactin measurement is not needed in women having regular menstrual cycles. What are the implications of these findings for clinical practice and/or further research? Hyperprolactinaemia was not uncommon in ovulatory women, although most had mildly elevated levels. Hyperprolactinaemia did not have any impact on fertility treatment outcome. Serum prolactin should not be tested in ovulating women, as mild elevations are commonly present and have no clinical significance.

Delayed ejaculation in men with depressive disorders.

Delayed ejaculation belongs to the group of sexual disorders in men. The causes of delayed ejaculation or anejaculation are not exactly known. It is assumed that it can be caused by psychogenic or organic influences or their combinations. One of the causes of delayed ejaculation may be elevated prolactin levels, which may be increased by psychosocial stress, pituitary disorders or also treatment with selective serotonin reuptake inhibitors in the treatment of depression. We tested a selected group of 50 men who were diagnosed with a depressive disorder and whose antidepressant treatment lasted for at least 24weeks. These patients reported long-term delayed ejaculation or, in some cases, anejaculation as comorbidity. The results showed significant Spearman's correlation between elevated prolactin levels and intravaginal ejaculation latency values (R=0.45), as well as between Beck's Depression-II inventory and intravaginal ejaculation latency and latency values (R=0.48).

Correlation Between Traumatic Brain Injuries and Callus Formation in Long bone Fractures.

Orthopaedic aphorism teaches that fractures of long bones when associated with head injuries frequently heal with excessive callus and at a faster rate than normal. However, the evidence on this subject is flimsy and the aphorism remains unsubstantiated. Numerous studies have been conducted evaluating the possible humoral and other factors involved leading to excess callus formation in patients with a head injury. This study was designed to evaluate the effects of a traumatic head injury on bone healing in adults with a diaphyseal fracture of the lower limb. Fiveteen patients with a closed fracture of tibia or femur and associated head injury (cases) and 15 patients with a closed fracture of tibia or femur without an associated head injury (controls) were included in the study. All patients were evaluated in terms of various serum parameters, including IL-6, growth hormone, PTH, LDH, prolactin levels, and ALP. Head injuries were graded as mild, moderate, or severe. Ventilatory support if required was noted. Serum prolactin was repeated at 5weeks. Patients were followed up with serial radiographs, and the volume of callus formed was calculated and compared. The mean value of growth hormone, interleukin-6 levels, and prolactin levels at 5weeks were found to be higher in patients with head injuries, and the difference was highly significant (p = 0.001). The severity of head injury also correlated proportionately with the spike in IL-6 levels. There was more pronounced callus formation in patients with head injury group when compared to the controls. This difference was significant at all intervals. There was higher volume of callus noted at the end of 6months in patients with severe head injury (GCS < 7) when compared to patients with moderate head injury (GCS > 7). The patients with severe head injury were naturally under ventilator support for a prolonged period compared to those with moderate head injury. It was thus indiscernible if the excess callus observed is due to the humoral cascade or as an effect of prolonged ventilation. Patients with head injuries show elevated parathyroid hormone levels, growth hormone levels at the time of injury, and elevated prolactin levels 5weeks after the trauma-all of which might contribute to enhanced osteogenesis. Interleukin-6 levels are also elevated and the levels correlate to severity of head injury. Head injury triggers a humoral cascade invloving interleukin-6, parathyroid hormoe, growth hormone, and prolactin that contributes to enhanced fracture healing.

A Case-control Study of Sexual Dysfunction and Serum Prolactin Levels in Patients with Psychotic Disorders

Introduction: Sexual functioning has remained widely neglected aspect of patient care for those suffering from severe mental disorders and has received little attention. Yet, it has been construed as one of the major factors contributing to nonadherence with antipsychotic medications. Aim: To study sexual dysfunction in patients with psychotic disorders and its clinical association with serum prolactin levels. Materials and Methods: This case-control study was conducted in the Department of Psychiatry at MGM Medical College and associated Mental Hospital, Indore, Madhya Pradesh, India, from 13th February 2020 to 21st January 2021. The study sample consisted of 200 subjects including 100 cases and 100 controls. The case group included patients with a diagnosis of psychotic disorders currently in remission for at least 1 month. Remission of the patients was ensured by Brief Psychiatric Rating Scale (BPRS) with a score of &lt;4 on all items and &lt;28 total score. Assessment of sexual dysfunction was done using Arizona Sexual Experience Scale (ASEX). The control group included healthy subjects aged between 18-65 years, either sex having active sexual partners with a score of &lt; 3 on all the items of the General Health Questionnaire (GHQ-12). Collection of blood sample was done and serum was analyzed for prolactin levels using the Chemiluminescent Microparticle Immunoassay (CMIA) method. Statistical analysis was done using Statistical Package for the Social Sciences version 28.0 (SPSS) for windows. Results: The mean age of the case group was 39.9±7.457 years while that of the control group was 35.60±9.37 years. The number of male patients (71% and 73%) was higher than females (29% and 27%) in the control group and case group respectively. The difference between the two were statistically significant. The total number of cases who experienced sexual dysfunction came out to be 59 out of 100. Total 55.93% of those having sexual dysfunction were suffering from difficulty in sexual arousal, followed by difficulty with penile erection/vaginal lubrication (49.15%), orgasmic dysfunction (34.48%), and reduced sexual drive (23.72%). Among the cases, the mean serum prolactin level (14.14±10.60 ng/mL) was seen to be significantly higher (p-value &lt;0.001) than the control group (9.46±6.05 ng/mL). Maximum serum prolactin level (29.00±9.95 ng/mL) was seen to be associated with usage of a combination of both 1st and 2nd generation antipsychotics. Conclusion: There was a significant prevalence of sexual dysfunction in psychotic patients and is associated significantly with elevated serum prolactin levels.

The Expression of Prolactin Receptors in Benign Breast Tumors Is Not Associated with Serum Prolactin Level.

The role of prolactin (PRL) and its receptors in the initiation and development of benign breast tumors (BBT) has not been sufficiently studied. An imbalance in the system of hormone homeostasis is crucial in the development of BBT. In particular, an association between elevated prolactin levels and the development of BBT has been reported. Our study showed no significant differences between PRL receptor (PRL-R) expression in BBT tissue under normal and elevated serum PRL levels. There was also no significant correlation between age, PRL-R expression in BBT tissue, intact tissue, and PRL level in the serum. There was a strong significant correlation (p < 0.01; r = 0.92) between PRL-R expression in BBT samples and intact breast tissue, which did not depend on the serum PRL level. There was also no significant difference in the expression of the proliferative marker Ki-67 in BBT tissues from women with normal and elevated levels of serum PRL (p > 0.05). No signs of PRL and its receptors were detected in the BBT cystic fluid women with elevated serum PRL levels. In summary, our prospective study showed that the expression of PRL-R in the tissue of BBT and physiological breast tissue does not depend on the level of serum PRL.

P.0575 DRD2/ANKK1 Taq1A polymorphism is associated with elevated serum prolactin levels during haloperidol treatment in schizophrenia spectrum disorders patients

P.0575 DRD2/ANKK1 Taq1A polymorphism is associated with elevated serum prolactin levels during haloperidol treatment in schizophrenia spectrum disorders patients

Acute Sheehan’s syndrome manifesting initially with diabetes insipidus postpartum: a case report and systematic literature review

PurposeAcute Sheehan’s syndrome is a rare, but potentially life-threatening, obstetric event that can be complicated by diabetes insipidus. Little information on the diagnosis and treatment of Sheehan’s syndrome with diabetes insipidus is available. We report on a 28-year-old patient who developed acute Sheehan’s syndrome with diabetes insipidus after giving birth, and on a systematic review of similar cases.MethodsWe performed a systematic review of the literature cataloged in PubMed and Google Scholar using the keywords “Sheehan syndrome” OR “Sheehan's syndrome” AND “diabetes insipidus” to identify relevant case reports published between 1990 and 2021. Eight Reports met the inclusion criteria (English-language abstracts available, onset in the puerperium, information about the day of the onset).ResultsIn the present case, postpartum curettage was necessary to remove the residual placenta. The total amount of blood loss was severe (2500 ml). On the second day postpartal, the patient developed polyuria. Laboratory analysis revealed hypernatremia with increased serum osmolality and decreased urinary osmolality. Hormone analysis showed partial hypopituitarism involving the thyroid, corticotropic, and gonadotropic axes. The prolactin level was elevated. Brain magnetic resonance imaging showed pituitary gland infarction. Desmopressin therapy was initiated and resolved the polyuria. Hormone replacement therapy was administered. Four months later, the patient was well, with partial diabetes insipidus. The literature review indicated that this case was typical in terms of symptoms and disease onset. Most reported cases involve hypotension and peripartum hemorrhage, but some patients without hemorrhage also develop Sheehan’s syndrome. Elevated prolactin levels are uncommon and associated with poor prognosis in patients with Sheehan’s syndrome.ConclusionAcute Sheehan’s syndrome with diabetes insipidus involves nearly all pituitary hormone axes, indicating severe disease. Prolactin elevation could suggest that a case of Sheehan’s syndrome is severe.

Change in Insulin Sensitivity and Lipid Profile After Dopamine Agonist Therapy in Patients With Prolactinoma.

BackgroundProlactinomas are prolactin(PRL)-secreting neoplastic lesions that can lead to metabolic disturbances and insulin resistance. We aimed to find the change in insulin sensitivity and lipid profile in prolactinoma patients after dopamine therapy. MethodologyA prospective observational study was conducted at the Hayatabad Medical Complex, Peshawar between June 2019 to July 2020. All patients with newly diagnosed prolactinoma were eligible to partake in the study. Individuals with multiple hormone-producing pituitary tumors, hyperprolactinemia secondary to other causes than tumors, and those taking medication for hypercholesterolemia were excluded. Diagnosis of prolactinoma was established on the basis of elevated PRL levels on at least two occasions three days apart in addition to an MRI detecting prolactinoma on the hypothalamic-pituitary area. The mean dose for dopamine agonist was 5.8 ± 4.1 mg per day with a range between 1.25 to 15 mg. To assess the change in insulin resistance, the homeostatic model assessment insulin resistance (HOMA-IR) was computed. All data were recorded in a predefined proforma. Results The difference between pre- and post-treatment values for mean PRL levels was statistically significant (p<0.0001). There was a significant association between dopamine agonist treatment and the BMI (pre- vs. post-treatment; 28.9 ± 4.28 vs. 24.53 ± 2.2, p<0.0001). Both low-density lipoprotein (LDL)-cholesterol and HOMA-IR scores were significantly lower in the post-treatment group as compared to the pre-treatment group (p<0.0001). ConclusionThe present study indicated that dopamine agonist therapy was effective not only in lowering the serum PRL levels but also improved insulin sensitivity and decreased lipid metabolism, resulting in improved BMI. Further studies should explore the long-term side effects of dopamine agonists on patients with prolactinoma.

Levels of prolactin and testosterone and associated sexual dysfunction and breast abnormalities in men with schizophrenia treated with antipsychotic medications

Sexual dysfunction is one of the most bothersome adverse drug effects seen in men and women taking antipsychotic medications and negatively impacts medication adherence. Antipsychotic medications are associated with hyperprolactinemia, which is known to contribute to sexual and hormonal side effects in men. However, testosterone also plays a key factor in male sexual function and may be affected by abnormal prolactin levels through gonadotropin-releasing hormone inhibition. This study was a pilot study undertaken to assess the prevalence of elevations in prolactin levels, related reductions in testosterone levels, associated symptoms of sexual dysfunction and breast abnormalities in male participants, and related distress to these symptoms in men taking prolactin-elevating antipsychotic medications. The study was conducted as a cross-sectional study. Our results showed a notably high prevalence of sexual side effects in this population, with gynecomastia occurring in 50% and penile-related symptoms in 73%. Additionally, we found elevated prolactin levels in 68% and low testosterone levels in 55% of our participants. This study was limited in its power due to a small sample size of 22 men and the lack of a control group. Still, even in our relatively small sample, we see a trend of hyperprolactinemia being associated with low testosterone and a significant correlation of low testosterone levels with penile-related symptoms. This suggests that testosterone plays a major role in the sexual side effects reported by men taking antipsychotics, although larger studies are needed to further categorize this relationship.

Impact of Serum Prolactin and Testosterone Levels on Male Infertility in Sulaimanyah City

The appropriateness of the interactions between Prolactin, gonadotrophins and testicular hormones ensures that normal spermatogenesis takes place in the male. So this study is an attempt to classify male infertility depending on WHO criteria of seminal changes and to evaluate serum Prolactin, Testosterone FSH and LH levels in the participants, also determine the association between serum Prolactin, Testosterone levels and subtypes of male infertility. This study involved three hundred infertile males having infertility more than one year (cases group) and three hundred age-matched fertile males with definite paternity in past two years (control group) were included to the study from Jan 2018 -Dec 2020 at Shahid Ali Qader consultant clinic in the Sulaimanyah city. Serum levels of hormones were measured by electrochemiluminescense immunoassay technique. Approximately half of patient's age ranged between 30- 39 years. Sixty eight percentage of cases complained from primary infertility. About 71.3% of patients had infertility duration between 1 - 5 years. This percentage decreased with increasing the infertility years. Most common infertile group was Asthenospermia (34.3%). A higher significant levels of serum Prolactin, FSH and LH found in cases than controls (p<0.001). However, the serum Testosterone levels was significantly lower in cases than controls (p<0.05). Moreover, serum Prolactin levels were found significantly elevated in all infertile subgroups (except Normospermic subgroup) compared to control group, while serum Testosterone levels were significantly decreased in all infertile subgroups (except Normospermic subgroup) compared to control group (p<0.05). So we conclude that; Poor spermatogenesis is associated with high serum Prolactin, FSH,LH levels and low serum Testosterone levels in patients with male infertility. Moreover, elevated serum Prolactin levels and decreased serum Testosterone levels were significantly associated with A, AT, OAT, Azoo and OA infertile males. Keywords: Male infertility, primary and secondary infertility, Prolactin, Testosterone, spermatogenesis.

The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment.

The aim of the study was to assess the relationship between prolactin levels and sexual dysfunction in patients with schizophrenia who use olanzapine medication. The potential risk factors of hyperprolactinemia and sexual dysfunction were also investigated. Patients with schizophrenia undergoing olanzapine monotherapy were invited to participate in this cross-sectional study. The Arizona Sexual Experiences Scale (ASEX) and the Positive and Negative Syndrome Scale were used to evaluate subjective sexual dysfunction and psychopathology, respectively. Levels of prolactin and metabolic parameters were also measured. In total, 279 participants with schizophrenia were recruited. The overall incidences of hyperprolactinemia, sexual dysfunction, and metabolic syndrome were 51.6, 53.8, and 43.7%, respectively. Higher ASEX scores, higher insulin levels, female sex, and younger age were associated with hyperprolactinemia. Prolactin level was significantly correlated with ASEX score. Elevated prolactin levels, concomitant antidepressant, increased insulin resistance, longer illness duration, and female sex were associated with sexual dysfunction. Female participants recorded higher levels of sexual dysfunction than their male counterparts did, whereas male participants had comparatively lower prolactin levels and lower rates of spousal partnership. Hyperprolactinemia, metabolic syndrome, and sexual dysfunction are prevalent in patients with schizophrenia treated with olanzapine. Clinicians should maintain awareness of these problems and monitor them regularly with their patients.

The Vanishing Pituitary Tumor: A Case Report

Prolactinomas are the most common functional pituitary tumors and present with elevated serum prolactin levels. This may or may not be accompanied by mass-related clinical symptoms. Dopamine agonists are its principal treatment. Data on prolactinoma remission and relapse after treatment withdrawal are limited. Here we report a patient presenting with headache, amenorrhea, galactorrhea, visual field impairments and a high serum prolactin level. After a definitive diagnosis of pituitary macroadenoma, the patient was treated with bromocriptine. Twelve months after treatment, tumor size markedly reduced, there was resolution of symptoms and patient was eventually lost to follow-up. After 10 months without treatment, tumor recurred. Bromocriptine was resumed for 5 more years and discontinued thereafter. Since then, the patient has been asymptomatic for the past 12 years; surveillance imaging showed no tumor recurrence with annual prolactin level all within normal range. This case adds to the limited data confirming that dopamine agonists in patients with prolactinomas can be successfully discontinued with a high remission rate, provided that there is adequate duration of treatment and sufficient follow-up. J Endocrinol Metab. 2021;11(3-4):91-93 doi: https://doi.org/10.14740/jem753

The impact of metformin on prolactin levels in postmenopausal women

Metformin-induced reduction in prolactin levels is more pronounced in users of hormonal contraception than in non-users. The current study was aimed at investigating whether physiological concentrations of estradiol determine the impact of metformin on lactotrope secretory function. We studied two matched groups of postmenopausal women with elevated prolactin levels. Twenty-three women were on hormone replacement therapy (group 1), while the remaining ones (group 2, n=23) did not use sex hormones. Because of coexistent prediabetes, all individuals received metformin (2.55-3g daily) for the following six months. Circulating levels of total prolactin, monomeric prolactin, thyrotropin, gonadotropins, free thyroid hormones and estradiol were determined at the beginning and at the end of the study. Compared with group 1, group 2 was characterized by higher gonadotropin levels and lower estrogen levels. Although metformin reduced monomeric prolactin levels in both study groups, this effect was more pronounced in group 1 than in group 2. Only in group 1, metformin decreased total prolactin levels, while only in group 2 the drug reduced FSH levels. Metformin treatment did not affect circulating levels of the remaining hormones. The impact of metformin on total and monomeric prolactin levels correlated with baseline prolactin levels and with the degree of improvement in insulin sensitivity. The obtained results indicate that the impact of metformin on lactotrope secretory function is partially determined by the estrogen status of patients.

Recurrent Galactorrhoea: A consequence of unheeded primary hypothyroidism

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism.

Hypoprolactinemia and hyperprolactinemia in male schizophrenia patients treated with aripiprazole and risperidone and their relationships with testosterone levels.

AimSeveral reports have shown that risperidone increases prolactin concentrations, while aripiprazole decreases prolactin concentrations. The frequency of abnormal prolactin concentrations in patients with schizophrenia receiving these drugs is still unknown. Furthermore, although hyperprolactinemia leads to sexual dysfunction, the relationship between hyperprolactinemia and testosterone, which may be directly related to male sexual function, is not well understood.MethodsThe subjects were 94 male schizophrenia outpatients receiving risperidone or paliperidone (risperidone group) and 83 male schizophrenia outpatients receiving aripiprazole. We measured the serum prolactin and total and free testosterone concentrations. We compared the prolactin and testosterone levels in patients receiving risperidone or paliperidone and patients receiving aripiprazole.ResultsThe average serum prolactin concentration was 27.5 ± 13.1 ng/mL for the risperidone group and 3.9 ± 3.5 ng/mL for the aripiprazole group, and the concentrations were significantly different (P < .001). Hypoprolactinemia was observed in 75% of the aripiprazole group and hyperprolactinemia in 65% of the risperidone group. A positive correlation between prolactin levels and the risperidone daily dose was found, whereas a negative correlation between prolactin levels and the aripiprazole daily dose was observed. In the risperidone group, total testosterone concentrations were correlated with age, while free testosterone concentrations were inversely correlated with age and prolactin levels.ConclusionWe found very common hyperprolactinemia and hypoprolactinemia in the risperidone or paliperidone group and aripiprazole group, respectively. Testosterone concentrations were associated with elevated prolactin levels in patients receiving risperidone or paliperidone. Further studies are needed to determine the clinical relevance of abnormal prolactin concentrations in male and female patients with schizophrenia.

Vitamin D status determines the impact of metformin on circulating prolactin levels in premenopausal women.

Metformin was found to normalize secretory function of overactive pituitary cells. Its effect on circulating thyrotropin levels was more pronounced in women receiving exogenous vitamin D. The aim of the current study was to investigate whether vitamin D status determines the impact of metformin on prolactin levels in premenopausal women with hyperprolactinaemia. The study population consisted of three groups of women with prediabetes and elevated prolactin levels: vitamin D-naïve women with vitamin D insufficiency (group 1; n=19), women receiving vitamin D preparations because of vitamin D deficiency (group 2 n=20), as well as vitamin D-naïve women with normal vitamin D status (group 3 n=23). All participants were then treated with metformin (2.55-3g daily). Circulating levels of glucose, insulin, prolactin, thyrotropin, free thyroid hormones, gonadotropins, estradiol, calcium and 25-hydroxyvitamin were determined at baseline and six months later. At baseline, prolactin levels were higher in group 1 than in the remaining groups of patients. Although metformin decreased glucose levels and improved insulin sensitivity in all treatment groups, this effect was more pronounced in groups 2 and 3. Only in subjects with 25-hydroxyvitamin D levels within the reference range, metformin reduced prolactin levels. The impact on prolactin levels correlated with 25-hydroxyvitamin D levels and with the improvement in insulin sensitivity. The drug produced a neutral effect on circulating levels of thyrotropin, free thyroid hormones, gonadotropins, estradiol, calcium and 25-hydroxyvitamin D. The results of the current study suggest that the impact of metformin on secretory function of overactive lactotropes depends on the vitamin D status of patients.