Hyperprolactinemia In Patients Research Articles

Identification and Management of Hyperprolactinaemia in Patients With Intellectual Disabilities Who Are Prescribed Antipsychotic Medication: A Retrospective Audit

Identification and Management of Hyperprolactinaemia in Patients With Intellectual Disabilities Who Are Prescribed Antipsychotic Medication: A Retrospective Audit

Assessment of prevalence of hyperprolactinemia in patients taking antipsychotic drugs in a tertiary care hospital in eastern India

Background: Researches done over different parts of the world show that hyperprolactinemia in psychotic patients is dependent on many factors such as age, gender, any thyroidal abnormality, drugs such as antipsychotics or antidepressants, psychological stress, and genre of psychosis. In patients taking antipsychotic treatments, prolactin blood levels may rise up to 10 times the normal values. It is very important to differentiate between prolactin-secreting tumor in pituitary and antipsychotic-induced hyperprolactinemia. There has been fewer researches on this topic in Eastern India, so it aims to properly estimate the amount of prolactin rise; a patient has to face after taking anti-psychotic medications and might also help the psychiatrists to adjust the dosage of anti-psychotics or to add some other drugs to lower the prolactin level along with the anti-psychotics in Eastern India. Aim and Objectives: The aims and objectives of the study are to estimate serum prolactin in diagnosed psychiatric patients taking antipsychotic drugs for at least 3 months and to study the difference in serum prolactin between recently diagnosed psychiatric patients taking antipsychotic drugs for at least 3 months and age and gender-matched mentally healthy patients without any psychiatric complication and without any history of in taking antipsychotic drugs. Materials and Methods: The study was conducted over a period of 4 months at Central Laboratory, Dept of Biochemistry, MCK. Before the conduct of the study, informed consent was taken. Patients diagnosed with psychiatric illness and consuming at least one antipsychotic drug for at least 3 months were enrolled after going through inclusion–exclusion criteria. Serum prolactin was measured with help of CLIA (ADVIA CENTAUR). Results: As per our study done in Eastern Indian population, in the female group of psychiatric patients (aged between 18 and 45 years) taking antipsychotics, the prolactin level was 23.6 ± 4.5 ng/ml, and in age-matched control female group, prolactin level was 9.2 ± 3.1 ng/mL, the difference is statistically significant (P < 0.001). Moreover, in male psychiatric patients (aged between 18 and 45 years) taking antipsychotics, the prolactin level was 14.3 ± 1.7 ng/mL, and in age-matched control male group, prolactin level was 8.5 ± 1.5 ng/mL, the difference is statistically significant (P < 0.001). Conclusion: As per our study, psychiatric patients of both gender taking antipsychotic drugs had higher serum prolactin level than age and gender-matched mentally healthy persons not taking antipsychotic drugs. Though the limitation of this study was small sample size and another issue that must be taken into consideration is the fact that prolactin levels can also be dependent of menstrual cycles in women, and in our study, there were 40 (57%) females who were still menstruating.

Possibilities of multi-parameter ultrasonography in diagnostic and evaluation of Vitex agnus-castus treatment of patients with mastodynia and mastopathy

Objectives: 1) to determine the elasticity of normal breast tissue (parenchyma and premammary adipose tissue) in healthy women using ultrasound two-dimensional shear wave elastography (2D-SWE); 2) to reveal a possible correlation between increased stiffness of the breast parenchyma and hyperprolactinemia in patients with mastodynia and mastopathy; 3) to evaluate the ability of the Vitex agnus-castus drug to reduce the stiffness of the breast glandular tissue; 4) to objectify the ability of the Vitex agnus-castus drug to affect the thickness of the breast parenchyma, the condition of the milk ducts and cystic changes.Materials and methods. Breast tissue stiffness was investigated using 2D shear wave elastography (2D-SWE) in 32 women aged 18–52 with cyclic mastalgia/mastopathy before and after treatment with Vitex agnus-castus drug. A correlation was made with laboratory parameters (prolactin level), the general condition of the breast according to the results of ultrasonography in gray scale mode. The control group consisted of 78 women without complaints, without signs of diffuse and focal pathology of the mammary glands.Results. The 2D-SWE elastography showed normal values of breast tissue stiffness in women without pathology. 2D-SWE in symptomatic women made it possible to detect increased stiffness of the breast parenchyma, thereby screening for its diffuse changes. At the same time, dynamic changes in the softbreast tissue as a result of the treatment (parenchyma thickness, dilatation of the milk ducts, the presence of simple cystic foci (BI-RADS 2)) were diagnosed, analyzed and compared in grayscale mode ultrasonography (2D). The majority of patients (90,6%) noted a decrease in the level of prolactin after treatment. Statistical evidence of the positive effect of the Vitex agnus-castus drug in the treatment of mastodynia/mastopathy has been proven.Conclusions. Assessment of the basic breast tissue stiffness using 2D-SWE makes it possible to screen patients with its elevated values. This fact makes it possible to assign these women to the risk group of developing breast cancer. Evaluation of changes in the mechanical stiffness properties of the breast soft tissues makes it possible to evaluate and objectify the effectiveness of the treatment.

Intrasellar Pressure is Related to Endocrine Disturbances in Patients with Pituitary Tumors

The aim of this study was to investigate the association between intraoperative intrasellar pressure (ISP) and pre- and postoperative endocrine disturbances with focus on hyperprolactinemia and hypopituitarism in patients with pituitary tumors. The study is a consecutive, retrospective study with ISP collected prospectively. One hundred patients operated with transsphenoidal surgery due to a pituitary tumor, who had their ISP measured intraoperatively, were included. Data on patient endocrine status preoperatively and from 3-month postoperative follow-up were collected from medical records. The risk of preoperative hyperprolactinemia in patients with nonprolactinoma pituitary tumors increased with ISP (unit odds ratio 1.067, n= 70) (P= 0.041). Preoperative hyperprolactinemia was normalized at 3months after surgery. Mean ISP was higher in patients with preoperative thyroid-stimulating hormone (TSH) deficiency (25.3±9.2mmHg, n= 37) than in patients with intact thyroid axis (21.6±7.2mmHg, n= 50) (P= 0.041). No significant difference in ISP was found between patients with and without adrenocorticotropic hormone(ACTH) deficiency. No association was found between ISP and postoperative hypopituitarism at 3months after surgery. In patients with pituitary tumors, preoperative hypothyroidism and hyperprolactinemia may be associated with higher ISP. This is in line with the theory of pituitary stalk compression, suggested to be mediated by an elevated ISP. ISP does not predict the risk of postoperative hypopituitarism 3months after surgical treatment.

Hyperprolactinemia in patients taking antipsychotics: the importance of a shared approach between psychiatry and endocrinology

IntroductionHyperprolactinemia is a commonly encountered adverse effect of antipsychotic medication. Short and long-term repercussions of high prolactin, such as amenorrhea, sexual dysfunction, osteopenia and increased cardiovascular risk carry significant burden and may compromise therapeutic adherence. Despite its serious practical implications, hyperprolactinemia is still underscreened and its management neglected.ObjectivesTo review current clinical guidelines regarding the management of hyperprolactinemia associated with the use of antipsychotics, reflecting upon the importance and need to share the management of this risk with an endocrinology expert.MethodsWe performed a literature review to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia (British Association of Psychopharmacology [BAP], NICE, Maudsley Prescribing Guidelines, Royal Australian and New Zealand College of Psychiatrists), published over the last ten years, with a particular focus on its physical risks.ResultsMost guidelines do not recommend routine monitoring of prolactin levels in asymptomatic patients. NICE and BAP guidelines have suggested measuring the baseline prolactin level, but have not specified follow-up monitoring, while Maudsley guidelines have. Management strategies depend on factors such as sex, age, as well as the clinical manifestations that ensue. Different treatment strategies have been described, such as decreasing the dose of the antipsychotic, switching antipsychotics, adding aripiprazole or adding dopaminergic agonists. Referral to an endocrinology specialist should be made if the aetiology is unclear, prolactin levels continue to rise despite some intervention, the hyperprolactinaemia is severe (>3000 mIU/L) or there is suspected/confirmed pituitary adenoma. Further physical implications of having hyperprolactin are to be dressed by the endocrinology expert, namely those on bone metabolism, gonodal function and cancer risk.ConclusionsGiven the widespread use of antipsychotics and the need to have psychotic patients stabilized (sometimes with a lack of effective alternative), early detection and shared management of hyperprolactinemia are instrumental towards assisting both clinician’s and patients’ decision-making, be it towards lowering prolactin levels or managing its risk without compromising the antipsychotic’s efficacy.Disclosure of InterestNone Declared

Association of the Level of Serum Prolactin with Polymorphic Variants of the GRIN2A, GPM3, and GPM7 Genes in Patients with Schizophrenia Taking Conventional and Atypical Antipsychotics

The dopamine, serotonin and glutamate systems are jointly involved in the pathogenesis and pharmacotherapy of schizophrenia. We formulated a hypothesis that polymorphic variants of the GRIN2A, GRM3, and GRM7 genes may be associated with the development of hyperprolactinemia in patients with schizophrenia taking conventional and atypical antipsychotics as basic treatment. 432 Caucasian patients diagnosed with schizophrenia were examined. DNA was isolated from peripheral blood leukocytes using the standard phenol-chloroform method. For pilot genotyping, 12 SNPs in the GRIN2A gene, 4 SNPs in the GRM3 gene, and 6 SNPs in the GRM7 gene were selected. Allelic variants of the studied polymorphisms were determined by real-time PCR. The level of prolactin was determined by enzyme immunoassay. Among persons taking conventional antipsychotics, there were statistically significant differences in the distribution of genotype and allele frequencies in groups of patients with normal and elevated prolactin levels for the GRIN2A rs9989388 and GRIN2A rs7192557 polymorphic variants, as well as differences in serum prolactin levels depending on the genotype of the GRM7 rs3749380 polymorphic variant. Among persons taking atypical antipsychotics, statistically significant differences were found in the frequencies of genotypes and alleles of the GRM3 rs6465084 polymorphic variant. An association of polymorphic variants of the GRIN2A, GRM3, and GRM7 genes with the development of hyperprolactinemia in patients with schizophrenia taking conventional and atypical antipsychotics has been established for the first time. The identified associations of polymorphic variants of the GRIN2A, GRM3 and GRM7 genes with the development of hyperprolactinemia in patients with schizophrenia taking conventional and atypical antipsychotics have been established for the first time. These associations not only confirm the close connection of the dopaminergic, serotonergic, and glutamatergic systems in the development of schizophrenia, but also demonstrate the potential of taking into account the genetic component during therapy.

Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management

Background and purposeTo analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. Patients and methodsA retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. ResultsIn 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. ConclusionHyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.

3.102 Pharmacogenetic Variants Differentially Impact Hyperprolactinemia in Patients Treated With Risperidone or Paliperidone

Risperidone and its active metabolite, paliperidone, are used to treat bipolar disorder, schizophrenia, and irritability with ASD. Risperidone is metabolized by CYP2D6 into paliperidone. This study was undertaken to evaluate the CYP2D6 phenotype on side effects associated with risperidone and paliperidone, namely hyperprolactinemia.

Adjunctive treatment with aripiprazole for olanzapine-induced hyperprolactinemia

IntroductionHyperprolactinemia is a common unwanted antipsychotic-induced adverse effect, particularly in female patients, and can induce poor adherence to treatment. Aripiprazole is an antipsychotic with partial agonist activity over the dopamine D2 receptors which can be effective in reducing hyperprolactinemia in patients treated with antipsychotics.ObjectivesWe investigate the efficacy of adjunctive treatment with aripiprazole for olanzapine-induced hyperprolactinemia and related hormonal side effects (amenorrhea, oligomenorrhea) in female patients with schizophrenia.MethodsEight female patients (22 to 40 years old) participated in this study with a diagnosis of schizophrenia and hyperprolactinemia-related hormonal side effects (amenorrhea, oligomenorrhea). Patients were treated with aripiprazole 10 mg/day added to a fixed olanzapine dose of 20 mg/day. Serum prolactin levels were measured at baseline and after 2, 4, 6, and 8 weeks. Symptoms and side effects were assessed using the Brief Psychiatric Rating Scale, Clinical Global Impressions Severity scale, Barnes Akathisia Scale.ResultsAdjunctive treatment with aripiprazole resulted in significantly lower prolactin levels beginning at week 2. 87.5 % of patients at week 8 had prolactin levels normalize. Among 8 patients with menstrual disturbances, 75% of patients regained menstruation during the study. No significant changes were observed regarding psychopathology and adverse effect ratings.ConclusionsAdjunctive aripiprazole treatment is effective for resolving olanzapine-induced hyperprolactinemia and reinstatement of menstruation in female patients, provides significant improvement and it appears to be safe with a lower risk of metabolic syndrome, without increased risk of adverse effects.DisclosureNo significant relationships.

Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management

Background and purposeTo analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. Patients and methodsA retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. ResultsIn 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. ConclusionHyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.

The incidence of hyperprolactinemia in patients with breast cancer.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hyperprolactinemia in patients with high TSH levels with both clinical and subclinical hypothyroidism

Hyperprolactinemia is the most common endocrine disorder involving hypothalamic–pituitary axis. This results from multiple causes such as medications, hypothyroidism, and pituitary disorders. Hyperprolactinemia and hypothyroidism are closely interrelated conditions. The present study aimed to estimate serum prolactin levels and determine the prevalence of hyperprolactinemia in newly diagnosed subclinical and clinical hypothyroid patients and correlation between TSH and prolactin levels in subclinical and clinical hypothyroid patients.This study was conducted in the Department of Biochemistry, in collaboration with Department of Medicine, Department of Obstetrics and Gynecology, LATE BRKM Government Medical College, Jagdalpur, Chhattisgarh, India. Total of 138 patients presenting to Department of Medicine for various thyroid related problems were involved in this study. The newly diagnosed cases of primary hypothyroidism were included in this study. The demographic, physical and clinical history was taken from all the study subjects. In the present study, serum prolactin levels were significantly increased in subclinical (28.7 ± 6.4 ng/mL) and clinical hypothyroidism (15.02 ± 4.2ng/mL) compared to controls. Hyperprolactinemia was observed in 11 (22.9%) patients in subclinical hypothyroidism and 4 (8.3%) in clinical hypothyroid patients. In the subclinical hypothyroidism and clinical hypothyroidism, the serum TSH levels were (17.01 ± 8.2 μU/l, 7.3 ± 2.0 μU/l respectively) significantly increased than the controls. In the clinical hypothyroidism and subclinical hypothyroidism, the serum free T3 (fT3) levels were (5.6 ± 0.68 pmol/l, 2.54 ± 0.43 pmol/l respectively) significantly increased than the controls. In the clinical hypothyroidism and subclinical hypothyroidism, the serum total T3 (T3) levels were (1.27± 0.24 nmol/l, 0.59±0.12 nmol/l respectively) significantly increased than the controls. The study results may conclude that, prolactin regulation is altered, in patients with clinical and subclinical hypothyroidism. Thyroid functions tests ought to be conducted in patients with hyperprolactinemia prior to performing further tests.

Opioids and pituitary function: expert opinion.

Opioids are highly addictive potent analgesics and anti-allodynics whose use has dramatically increased in recent decades. The precipitous rise in opioid dependency and opioid use disorder is an important public health challenge given the risks for severely adverse health outcomes. The long-term opioid impact on hypothalamic-pituitary axes is particularly underappreciated among both endocrinologists and primary care physicians. We review the effects of opioids on hypothalamic-pituitary-target gland function and their implications for clinical practice. Experts in hypothalamic-pituitary disorders and opioid pharmacology reviewed recently published literature and considered strategies for diagnosing and managing these opioid-induced endocrine effects. Opioid suppression of hypothalamic-pituitary axes can lead to hypogonadotropic hypogonadism, central adrenal insufficiency, and hyperprolactinemia. These important clinical manifestations are often under-estimated, poorly evaluated, and typically either untreated or not optimally managed. Data on biochemical testing for diagnosis and on the effect of hormone replacement in these patients is limited and prospective randomized controlled studies for guiding clinical practice are lacking. Patients should be informed about risks for hypogonadism, adrenal insufficiency, and hyperprolactinemia, and encouraged to report associated symptoms. Based on currently available evidence, we recommend clinical and biochemical evaluation for potential central adrenal insufficiency, central hypogonadism, and/or hyperprolactinemia in patients chronically treated with opioids as well as the use of current expert guidelines for the diagnosis and treatment of these conditions.

Efficacy and Safety of Adjunctive Aripiprazole, Metformin, and Paeoniae-Glycyrrhiza Decoction for Antipsychotic-Induced Hyperprolactinemia: A Network Meta-Analysis of Randomized Controlled Trials.

Aripiprazole, metformin, and paeoniae–glycyrrhiza decoction (PGD) have been widely used as adjunctive treatments to reduce antipsychotic (AP)-induced hyperprolactinemia in patients with schizophrenia. However, the comparative efficacy and safety of these medications have not been previously studied. A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety between aripiprazole, metformin, and PGD as adjunctive medications in reducing AP-induced hyperprolactinemia in schizophrenia. Both international (PubMed, PsycINFO, EMBASE, and Cochrane Library databases) and Chinese (WanFang, Chinese Biomedical, and Chinese National Knowledge infrastructure) databases were searched from their inception until January 3, 2019. Data were analyzed using the Bayesian Markov Chain Monte Carlo simulations with the WinBUGS software. A total of 62 RCTs with 5,550 participants were included in the meta-analysis. Of the nine groups of treatments included, adjunctive aripiprazole (<5 mg/day) was associated with the most significant reduction in prolactin levels compared to placebo (posterior MD = −65.52, 95% CI = −104.91, −24.08) and the other eight treatment groups. Moreover, adjunctive PGD (>1:1) was associated with the lowest rate of all-cause discontinuation compared to placebo (posterior odds ratio = 0.45, 95% CI = 0.10, 3.13) and adjunctive aripiprazole (>10 mg/day) was associated with fewer total adverse drug events than placebo (posterior OR = 0.93, 95% CI = 0.65, 1.77) and other eight treatment groups. In addition, when risperidone, amisulpride, and olanzapine were the primary AP medications, adjunctive paeoniae/glycyrrhiza = 1:1, aripiprazole <5 mg/day, and aripiprazole >10 mg/day were the most effective treatments in reducing the prolactin levels, respectively. Adjunctive aripiprazole, metformin, and PGD showed beneficial effects in reducing AP-induced hyperprolactinemia in schizophrenia, with aripiprazole (<5 mg/day) being the most effective one.

A case of hyperprolactinaemia in a patient with metastatic melanoma

Ectopic prolactin production from a malignancy is infrequently reported. We report here a 60-year-old gentleman who presented with hyperprolactinaemia (9100 mIU/L) causing expressible galactorrhoea, decreased libido and fatigue thought to be due to ectopic prolactin secretion from a metastatic melanoma. Upon initiation of pembrolizumab, the patient's symptoms resolved and he became normoprolactinaemic. This corresponded with a partial response on radiological imaging. Although the core biopsy of the metastatic melanoma did not exhibit immunostaining for prolactin, we believe that only a subset of the tumour cells possesses prolactin-secreting capacity. This case illustrates the need to consider ectopic prolactin production for a solid malignant tumour as a rare cause of hyperprolactinaemia in patients with a normal pituitary MRI, in the absence of other causes.

Guidance on the treatment of antipsychotic-induced hyperprolactinemia when switching the antipsychotic is not an option.

DisclaimerIn an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.PurposeThis article aims to evaluate management options for antipsychotic-induced hyperprolactinemia and associated treatment considerations such as efficacy, tolerability, drug interactions, contraindications, and dosing regimens.SummaryHyperprolactinemia is a common adverse effect of antipsychotics. First-line management includes reducing the dose of the offending antipsychotic, discontinuing the antipsychotic, or switching to another antipsychotic associated with a lower risk of hyperprolactinemia. However, these options are not always practical and are associated with a risk of relapse of the psychiatric illness. Other management options include adjunctive aripiprazole, dopamine agonists (cabergoline and bromocriptine), metformin, and herbal supplements. A search of Embase, PubMed, and Google Scholar using key terms such as hyperprolactinemia, prolactin, antipsychotic, treatment guidelines, aripiprazole, dopamine agonist, cabergoline, bromocriptine, metformin, herbals, supplements, and medications was conducted for literature retrieval. Upon evaluation of the available literature we found the following: (1) aripiprazole is safe and effective in lowering prolactin levels within normal limits; (2) adjunctive cabergoline and bromocriptine decrease elevated prolactin levels, while cabergoline may be more effective in reducing prolactin but can also be associated with a more serious adverse effect of cardiac valvular abnormalities; (3) metformin causes a mild reduction of prolactin levels; and (4) there are limited data to support use of herbal medications (chamomile, Peony-Glycyrrhiza decoction, and shakuyaku-kanzo-to) in antipsychotic-induced hyperprolactinemiaConclusionThere are treatments available for antipsychotic-induced hyperprolactinemia in patients who are unable to alter their current antipsychotic regimen. However, there remains a need for additional short- and long-term studies to determine the efficacy and safety of these treatment strategies, given that patients taking antipsychotics typically require chronic, life-long treatment for their illnesses.

Hyperprolactinemia in patients with chronic kidney disease

Despite rapid progress in improving dialysis technology in recent years, mortality in hemodialysis (HD) patients remains quite high. The main reasons are cardiovascular disease. The search of factors that are associated with an increased risk of adverse clinical events in patients with chronic kidney disease (CKD) is an urgent problem of modern nephrology.&#x0D; Prolactin (PL) is a unique hormone that can perform the functions of both a hormone and a neuropeptide. Among patients with CKD, the frequency of hyperprolactinemia (HPL) increases with decreasing glomerular filtration rate (GFR). There is a moderate HPL due to impaired degradation of PL in the kidneys. Hemodialysis does not affect the level of PL. A negative correlation between the levels of PL and GFR, PL and albumin levels and PL and Hb levels are shown in the studies. Serum PL is positively correlated with blood pressure and the risk of cardiovascular events.&#x0D; Despite the relatively high prevalence of HPL in patients with CKD, particularly in the dialysis population, there is uncertainty about the consequences of this condition for this cohort of patients. Further studies are needed to study the effects of HPL on clinical outcomes in patients with CKD. If a causal relationship between HPL and clinical outcomes, in particular cardiovascular events, is shown, HPL may be a potential target for therapeutic interventions.

Assessment of Hyperprolactinemia in Drug Naive Patients with Depression

Introduction: Patients with hyperprolactinemia often present with emotional difficulties, which occasionally persist even after treatment with dopamine agonists. There is an unusual prevalence of hyperprolactinemia in patients with depressive disorder. Prolactin is a hormone of the anterior pituitary and its secretion is regulated by Thyrotropin-Releasing Hormone (TRH) and Dopamine. Several studies have shown that antidepressants that inhibit serotonin reuptake can cause hyperprolactinemia which in turn leads to several complications like galactorrhoea, sexual dysfunction and several hormonal imbalances. This study was envisaged to assess baseline prolactin levels before administering any antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) in patients with depression. Aim: To assess serum prolactin level in drug naive patients with depression attending psychiatric Out Patient Department (OPD) of a tertiary care hospital and to compare its level with healthy controls. Materials and Methods: The present study was a cross-sectional, descriptive hospital based study. The duration of the study was 12 months. The study was conducted at the Department of Biochemistry and Psychiatry OPD of College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India. Forty drug naive depression patients were selected as cases and 40 age and sex matched healthy individuals randomly were taken as controls. Results: A total of 40 Major Depressive Disorder (MDD) patients were studied with a gender distribution of 10 males (25%) and 30 females (75%), age ranging from 21-50 years with the majority (90%) of the participants belonging to Hindu community. Among cases (n=40) Median value of prolactin concentration was 19.7 ng/mL (Z=-2.879,p=0.004) among controls (n=40) Median value of prolactin concentration was 13.6 ng/mL.There was significant positive correlation between HAM-D and serum Prolactin levels. Conclusion: There should be restrictive use of SSRI in hyperprolactinemia in patients suffering from depression.

Utility of Cannulated Prolactin to Exclude Stress Hyperprolactinemia in Patients with Persistent Mild Hyperprolactinemia.

Background:Stress-induced hyperprolactinemia can be difficult to differentiate from true hyperprolactinema and may result in patients having unnecessary investigations and imaging. We report the results of cannulated prolactin tests with serial prolactin measurements from an indwelling catheter to differentiate true from stress-induced hyperprolactinemia in patients with persistently mildly elevated prolactin levels in both referral and repeat samples.Methods:Data were collected for 42 patients who had a cannulated prolactin test between January 2017 and May 2018. After cannula insertion, prolactin was measured at 0, 60, and 120 minutes. Normalization is defined as a decline in prolactin to gender-defined normal ranges.Results:The mean age was 33.8 years (SD ± 9.9), and 37 (88%) were female. Menstrual irregularities were the main presenting symptom in 28.57% of the patients. Prolactin normalized in 12 (28.6%) patients of whom cannulated prolactin test was done. Repeat random prolactin levels were significantly higher in patients whose prolactin did not normalize during the cannulated prolactin test. MRI of the pituitary gland showed an abnormality in 23 out of 28 (82%) patients who did not normalize prolactin, a microadenoma in the majority of patients (18 patients).Conclusion:The cannulated prolactin test was useful in excluding true hyperprolactinemia in 28.6% of patients with previously confirmed mildly elevated random prolactin on two occasions, thus avoiding over-diagnosis and unnecessary imaging.

Pharmacogenomic Studies in Intellectual Disabilities and Autism Spectrum Disorder: A Systematic Review.

Individuals with intellectual disability (ID) and autism spectrum disorder (ASD) often receive psychotropic medications such as antipsychotics and antidepressants to treat aberrant behaviors and mood symptoms, frequently resulting in polypharmacy and drug-related adverse effects. Pharmacogenomic (PGx) studies with ASD and/or ID (ASD/ID) have been scarce despite the promise of optimizing treatment outcomes. We reviewed the literature on PGx studies with antipsychotics and antidepressants (e.g., treatment response and adverse effects) in ASD/ID. We performed a systematic review using MEDLINE, Embase, and PsycINFO, including peer-reviewed original articles in English referring to PGx in the treatment of ASD/ID in any age groups (e.g., treatment response and adverse effects). A total of 28 PGx studies using mostly candidate gene approaches were identified across age groups. Notably, only 3 studies included adults with ASD/ID while the other 25 studies focused specifically on children/adolescents with ASD/ID. Twelve studies primarily investigated treatment response, of which 5 and 6 studies included patients treated with antipsychotics and antidepressants, respectively. Most interesting results for response were reported for 2 sets of candidate gene studies, namely: (1) The DRD3 Ser9Gly (rs6280) polymorphism was examined in patients treated with risperidone in 3 studies, 2 of which reported an association with risperidone treatment response and (2) the SLC6A4 5-HTTLPR polymorphism and treatment response to antidepressants which was investigated in 4 studies, 3 of which reported significant associations. In regard to side effects, 9 of 15 studies focused on hyperprolactinemia in patients treated with risperidone. Among them, 7 and 5 studies examined the impact of CYP2D6 and DRD2 Taq1A polymorphisms, respectively, yielding mostly negative study findings. There is limited data available on PGx in individuals with ASD/ID and in particular in adults. Given the potential for PGx testing in improving treatment outcomes, additional PGx studies for psychotropic treatment in ASD/ID across age groups are warranted.