Increased Serum Prolactin Levels Research Articles

Safety and Tolerability of Antipsychotic Drugs in Pediatric Patients: Data From a 1-Year Naturalistic Study.

Background: Antipsychotic drugs (APs) are increasingly used to treat a variety of psychiatric disorders in children and adolescents. However, their safety and tolerability profiles, when used in a developmental age context, show different characteristics from the ones observed in adult patients. Treatment with APs in pediatric patients is often long-term. However, the tolerability data regarding these patients mostly derive from short-term studies.Methods: Starting from April 2017, for a 1-year period, patients between 4 and 18 years of age followed by five units of developmental age neuropsychiatry, who initiated a treatment with at least an AP (ATC class N05A) were included into the study. Patient-related data have been collected at baseline and regularly thereafter, as allowed by the clinical routine. Changes to continuous variables over time have been analyzed using a linear mixed model in subsamples of our population treated with risperidone or aripiprazole.Results: During the observation period, 158 patients were initially enrolled, but only 116 completed 12 months of therapy with an AP. Risperidone was the most used AP (n = 52) followed by aripiprazole (n = 44) and olanzapine (n = 7). For both the aripiprazole and risperidone groups, the mean body mass index (BMI) (P < 0.001 for both groups) and heart rate (P = 0.026 for aripiprazole group and P < 0.001 for the risperidone one) values significantly increased over time. The mean prolactin concentration value significantly increased over time only in the risperidone group (P = 0.04). Eighty-six patients experienced at least one adverse drug reaction (ADR), accounting for a total of 238 specific reactions, with the most frequent being weight gain (n = 34), increased serum prolactin levels (n = 21), hyperphagia (n = 20), and hypercholesterolemia (n = 14). Among these, only 24 ADRs were classifiable as serious.Conclusions: The results of this study confirm that risperidone and aripiprazole are relatively well-tolerated therapeutic options for the treatment of a variety of psychiatric disorders in pediatric patients. However, in findings such as statistically significant increments of BMI and heart rate mean values, the variations over time in prolactin levels observed with risperidone and the differences between the two drugs remark the necessity of systematic monitoring.

Association Between Antipsychotics and Osteoporosis Based on Real-World Data.

Osteoporosis, which is a major public health concern, has been known to reduce health-related quality of life. Some studies have suggested that antipsychotics could perhaps cause osteoporosis by increasing serum prolactin levels. However, the association between antipsychotics and the risk for developing osteoporosis has been controversial. The present study aimed to assess the association between antipsychotic use and onset of osteoporosis in real-world settings. A multimethod data-mining approach using different algorithms and databases was used. First, disproportionality analysis was conducted using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (2004-2017) with reporting odds ratio (ROR) and information component (IC) being used to indicate a signal. Furthermore, a sequence symmetry analysis using data from a large Japanese administrative claims database (2005-2017; JMDC Inc, Japan) was conducted. Short-term intervals (ie, 12, 24, and 36 months) were set to investigate the association between antipsychotic use and onset of osteoporosis using the adjusted sequence ratio (SR) to indicate a signal. No potential association between osteoporosis and all antipsychotics was observed in the FAERS database, except for perphenazine, which exhibited significant signals using both ROR and IC. Moreover, no potential association between osteoporosis and antipsychotics was observed in the JMDC claims database, except for sulpiride and aripiprazole. None of the antipsychotics indicated significant signals using all analyzed items (ROR, IC, and adjusted SR). Real-world data show no association between antipsychotic use and the onset of osteoporosis. Further pharmacoepidemiological studies are needed for causality assessment.

Cariprazine

Abstract Objective Cariprazine is a new antipsychotic drug approved for the treatment of schizophrenia in Europe in 2017. Clinical studies suggest advantages of cariprazine in comparison to other antipsychotic agents regarding therapeutic effects on “negative symptoms”, antipsychotic-induced weight gain and increased serum prolactin levels. Akathisia was reported to be one of the most common side effects. Currently, however, data from naturalistic treatment settings regarding the efficacy, safety and tolerability of cariprazine are missing. Thus, we report and discuss our clinical experiences with cariprazine regarding efficacy, safety and tolerability in order to provide first treatment data from a naturalistic treatment setting. Material and methods The course of treatment of a series of 3 patients with schizophrenia spectrum disorders and treatment with cariprazine (mono- or combined therapy) is presented and discussed. Results Cariprazine demonstrated sufficient antipsychotic effects in 2 out of 3 cases; however, in 2 out of 3 cases treatment had to be discontinued due to akathisia/agitation; in 1 case, cariprazine monotherapy facilitated successful normalization of elevated prolactin serum levels (due to combined treatment with risperidone and olanzapine). Conclusion(s): In general, experience with cariprazine within a naturalistic treatment setting is in accordance with data from clinical studies, particularly concerning effects on “negative symptoms”, antipsychotic-associated elevation of prolactin serum levels and risk of akathisia. The comparatively high incidence of discontinuation of cariprazine due to akathisia/agitation in our case series may be an effect of polypharmacy which was very common among our three cases. Clinical relevance This case series provides some evidence that safety, tolerability and antipsychotic efficacy of cariprazine in naturalistic treatment settings may be similar to findings from the available clinical studies.

Vitex agnus-castus for the treatment of cyclic mastalgia: a systematic review and meta-analysis

Background: Cyclic mastalgia (CM) is premenstrual bilateral and diffuse breast pain that presents cyclically and affects women in their reproductive years. It may associate with latent hyperprolactinemia due to the insufficient inhibitory effect of dopamine on the pituitary gland. Vitex agnus-castus (VAC) is known for its dopaminergic activity and its possible actions on CM and latent hyperprolactinemia. However, the treatment effect of VAC on CM remains unclear.Materials and methods: To perform a systematic review and meta-analysis of clinical trials that report on the efficacy of VAC treatment in CM patients, literature search was performed in major research databases.Results: This review includes 25 studies (17 randomized control trials plus eight nonrandomized trials). VAC was effective in relieving breast pain intensity and lowering the increased serum prolactin level in reproductive age CM patients (18–45 years) with or without premenstrual syndromes. Typical dosage was 20–40 mg/day with a treatment duration of 3 months. A conservative meta-analysis included only six studies (n = 718: VAC – 356, placebo – 362) and revealed a moderate effect size (SMD 0.67, 95% CI 0.5–0.85) favoring VAC over a placebo. Seven trials demonstrated VAC to be a noninferior alternative to pharmaceutical therapies for CM, including dopamine agonists, nonsteroidal anti-inflammatory drugs, serotonin reuptake inhibitors, and hormonal contraceptives. VAC was safe and associated with only mild and reversible adverse events. However, the risk of bias in most studies was unclear due to insufficient information.Conclusion: VAC is a safe and effective treatment option for CM. More high-quality clinical trials are needed to strengthen the evidence base.

Effect of tramadol dependence on male sexual dysfunction.

Tramadol dependence became an increasing and alarming problem in the Egyptian community. Wide availability of tramadol as a pain killer and its role in the treatment of premature ejaculation may be the most apparent causes of increased magnitude of the problem among youth who believe that tramadol has a positive impact on their sexual functions. This study aimed to explore the real impact of chronic tramadol administration on sexual functions in males dependent on tramadol. The study was carried on 80 subjects (50 subjects were tramadol dependent group and 30 subjects represented the control group). Personal, family and past histories were obtained from all the participants in addition to the toxicological history from tramadol dependent group. Urine screening for tramadol was done for all cases of history of tramadol dependence then confirmation by HPLC technique to measure tramadol blood level was done. Both groups were investigated for serum testosterone and prolactin level. Curiosity (22%) and treatment of premature ejaculation (20%) were the main motives for dependence. Erectile dysfunction and decreased libido occurred in 44% and 48% of tramadol dependent group respectively. Significant increase in erectile dysfunction and decreased libido was noted as the duration of dependence increased. Additionally, significant decrease in serum testosterone level and increase in serum prolactin level as tramadol daily dose and duration increased was found. In conclusion, men who take tramadol for premature ejaculation or any other purpose must know that they are very susceptible to many sexual dysfunctions.

Risperidone Doesn't Appear to Increase Risk for Osteoporotic Fractures

Because risperidone increases serum prolactin levels, and hyperprolactinemia has been associated with osteoporosis and related fractures, clinicians

Vitex Agnus-Castus for the Treatment of Cyclic Mastalgia: A Systematic Review and Meta-Analysis.

Background: Cyclic mastalgia (CM) is premenstrual bilateral and diffuse breast pain that presents cyclically and affects women in their reproductive years. It may associate with latent hyperprolactinemia due to the insufficient inhibitory effect of dopamine on the pituitary gland. Vitex agnus-castus (VAC) is known for its dopaminergic activity and its possible actions on CM and latent hyperprolactinemia. However, the treatment effect of VAC on CM remains unclear. Materials and Methods: To perform a systematic review and meta-analysis of clinical trials that report on the efficacy of VAC treatment in CM patients, literature search was performed in major research databases. Results: This review includes 25 studies (17 randomized control trials plus eight nonrandomized trials). VAC was effective in relieving breast pain intensity and lowering the increased serum prolactin level in reproductive age CM patients (18-45 years) with or without premenstrual syndromes. Typical dosage was 20-40 mg/day with a treatment duration of 3 months. A conservative meta-analysis included only six studies (n = 718, VAC = 356, placebo = 362) and revealed a moderate effect size (SMD: 0.67, 95% CI: 0.5-0.85) favoring VAC over a placebo. Seven trials demonstrated VAC to be a noninferior alternative to pharmaceutical therapies for CM, including dopamine agonists, nonsteroidal anti-inflammatory drugs, serotonin reuptake inhibitors, and hormonal contraceptives. VAC was safe and associated with only mild and reversible adverse events. However, the risk of bias in most studies was unclear due to insufficient information. Conclusions: VAC is a safe and effective treatment option for CM. More high-quality clinical trials are needed to strengthen the evidence base.

Milk Thistle Seed Extract Favorably Affects Lactation and Development of Mammary Gland in Female Rats

Milk thistle seed extract (Silbanummarianum), is a mixture of flavonolignans. The main active ingredients in S. marianum are silybin (silibinin), sylichrisitn, and silydianin, commonly referred to collectively as Sylimarin. Studies showed that Silymarin has anti-inflammatory and antioxidant properties. Seventy-two pregnant female Wister rats were randomly assigned to 3 study groups (24 rats in each group). Group 1, or a control group (C group), received drinking water daily for 14 days from the 8th day of gestation until the delivery. Group 2 (M) and Group 3 (S) received Metoclopramide (5mgkgday) and S. marianum seed extract (200 mgkgday), respectively, for 14 days. Dams’ body weights were monitored throughout the pregnancy. The weights of the newborns in the litter (which previously adjusted to 8 offsprings) were measured on the first day of parturition, and 8 dams from each group were randomly selected and sacrificed. Pregnant female rats in (S) group had litter of significantly higher body weight and increase serum prolactin level in pregnant female rats (p< 0.05). Milk thistle seed extract led to a marked hyperplasia in mammary gland tissue, with strong expression of prolactin receptors. Wister ratsinS. marianum and Metoclopramide groups showed significant increase in serum prolactin levels, had heavier offsprings, and histological and immunohistochemistry changes as compared to the animals that stopped receiving the treatment in the same group (p<0.05). We concluded that S. marianum enhances milk production and mammary gland development (galactogogues effect).

Transient Elevated Serum Prolactin in Trans Women Is Caused by Cyproterone Acetate Treatment.

Hormone treatment in trans women in Europe usually consists of the administration of estrogens and antiandrogens, for example, cyproterone acetate (CPA). Mild serum prolactin elevations during follow-up are attributed to estrogen therapy. This analysis evaluates whether CPA contributes to the elevation of prolactin in trans women receiving gender affirming hormones. This study is part of the endocrine part of the European Network for the Investigation of Gender Incongruence (ENIGI). Belgian data were selected for this substudy. Trans women who initiated gender affirming hormone treatment and underwent orchiectomy were prospectively evaluated. Trans women were treated with oral CPA 50 mg in combination with estrogen substitution. Postsurgery, estrogen was reinitiated in an unchanged dose. Sex steroids, gonadotropins, and prolactin were compared at baseline, pre- and postsurgery in patients receiving orchiectomy, and at baseline, 12, and 18 months in patients who did not undergo orchiectomy. One hundred and seven trans women participated in this analysis, with a mean age of 31.5 years. An increase in serum prolactin levels was seen in the group undergoing orchiectomy (23.72 μg/L) and not undergoing orchiectomy (23.05 μg/L) at the preoperative and 12-month visit, compared with baseline (9.42 μg/L, P = 0.002 and 9.94 μg/L, P < 0.001, respectively). After orchiectomy, a decline in prolactin levels (10.17 μg/L, P < 0.001) occurred. CPA is likely to cause a temporary increase in serum prolactin, with prolactin levels returning to normal after orchiectomy and CPA discontinuation.

Treatment patterns in schizophrenia: Clinical case of successful management with a series of long acting injectable antipsychotics

IntroductionWe report the successful management of a 57-year-old woman with a 20 year diagnostic of paranoid schizophrenia (first visit November, 1995). She presented several comorbidities (arterial hypertension, diabetes mellitus and morbid obesity), with a history of five previous hospitalizations (1995, 2012, January and May 2014, and April 2016).Aims/methodsThe patient was always prescribed depot antipsychotics: she was treated for 14 years with Zuclopentixol depot (discontinued due to dermic adverse reactions and weight gain). After a period with oral paliperidone (from 2012 until 2013) and due to lack of adherence to oral therapy, in August 2013 she was prescribed paliperidone palmitate. The treatment was discontinued after nine months (May 2014) due to weight gain, a significant increase of serum prolactin levels and two psychotic relapses that led to hospital admissions.ResultsShe was then prescribed Fluphenazine decanoate depot for one year and 4 months, but she was switched to Aripiprazole once monthly (AOM) in September 2015 to avoid metabolic syndrome.ConclusionsNon-personalized antipsychotic treatment in a patient with a complicated comorbidity history can result in lack of compliance and a risk of relapse, and in a worsening of her medical conditions, with the consequential negative impact in her functioning and quality of life. Based on our results, the treatment with AOM resulted in a positive evolution of the patient, with a good tolerability profile, in an improvement of treatment-caused adverse events (weight loss, and prolactin serum levels normalization); all factors that enable treatment adherence and good clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric Patients with Antipsychotic Drug-Induced Hyperprolactinemia and Menstruation Disorders.

Treatment with antipsychotic drugs has been associated with hyperprolactinemia. The same antipsychotic drugs have also been associated with side effects such as menstruation disorders. The aim of this study was to evaluate the prevalence of hyperprolactinemia and menstruation disorders in women undergoing antipsychotic treatment. We performed a retrospective chart review study of psychiatric patients who underwent laboratory testing for serum prolactin (PRL) level between March 2011 and March 2015 in Ehime University Hospital. Patients presenting with and without menstruation disorders were evaluated to determine if they presented concomitant hyperprolactinemia. Patients with menstrual disorders had a significant increase in serum PRL level with a mean of approximately 90 ng/mL. Those with menstrual disorders presented increased PRL levels by 2-fold that of patients without menstrual disorder. However, there was no significant difference in the equivalent dose of chlorpromazine between these two groups. Additionally, about 70% of patients with menstrual disorders received risperidone treatment. The receiver operating characteristic curve showed that the optimal cutoff point of serum PRL level associated with the development of menstrual disorders was 60 ng/mL. Based on these results, we concluded that patients with menstrual disorders presented increased serum PRL, and that most of them underwent treatment with risperidone.

Effect of Iloperidone on serum Prolactin in patients suffering from Schizophrenia

Background: Schizophrenia is a severe mental disease that is characterized by different psychopathological symptoms like disturbance of the affect, difficulty thinking or dysfunction of perception. Its lifetime prevalence is estimated at around 1%. It is well known that hyperprolactinaemia is a well documented side effect of most anti-psychotics. Hence this study was conducted to evaluate the elevation of serum prolactin levels in patients with schizophrenia on a latest second generation antipsychotic Iloperidone. Aim: The aim of this study was to investigate the changes in the levels and side effects of serum prolactin elevation in patients suffering from schizophrenia on treatment with atypical anti-psychotic Iloperidone. Methods: This is an open labeled, prospective study on Fifty patients (30 men and 20 women), diagnosed with schizophrenia according to the DSM 5 (Diagnostic and statistical Manual of Mental Disorders 5th Edition) criteria on treatment with Iloperidone. This study was conducted in the department of Psychiatry, Bhaskar medical college and General Hospital. Serum Prolactin levels, and the side effects related to elevated serum prolactin were assessed. ANOVA was used for statistical analysis using SPSS 16 version. Results: It was found that the majority of the study sample was in the age group of 21-30 years, male patients, belonging to Lower middle socio economic status, had their education till secondary level. The mean serum prolactin levels were increased from 12.95 ng/ml to 16.26 ng/ml at the end of three months. There was an increasing trend of serum prolactin levels in females and a reverse trend in males. Iloperidone increased the serum prolactin levels but did not cause any prolactin related side effects. It was found that use of Iloperidone in the higher age group did not increase serum prolactin levels even at the end of 90 days. Conclusions: There is an elevation of serum prolactin with the usage of Iloperidone. Iloperidone at dose of 12-20mg/day is a safer and a better alternative treatment option for patients being treated on second generation anti-psychotics who are suffering from increase in serum prolactin and its adverse effects.

Time Course of Resolution of Hyperprolactinemia After Transsphenoidal Surgery Among Patients Presenting with Pituitary Stalk Compression

Primary lactotroph disinhibition, or stalk effect, occurs when mechanical compression of the pituitary stalk disrupts the tonic inhibition by dopamine released by the hypothalamus. The resolution of pituitary stalk effect-related hyperprolactinemia postoperatively has not been studied in a large cohort of patients. We performed a retrospective review to investigate the time course of recovery of lactotroph disinhibition after transsphenoidal surgery. Medical records were retrospectively reviewed for all patients undergoing transsphenoidal surgery with the senior author from April 2008 to November2014. Of 556 pituitary adenomas, 289 (52.0%) were eliminated: 77 (13.9%) had an immunohistochemically confirmed prolactinoma, 119 (21.4%) patients had previous surgery, 93 (16.7%) had incomplete medical records, leaving 267 patients (48.0%) for final analysis. Of these patients, 72 (27.0%) had increased serum prolactin levels (≥23.3 ng/mL), suggestive of pituitary stalk effect (maximum prolactin level= 148.0 ng/mL). Patients with stalk effect were more likely than those with normal serum prolactin levels to present with menstrual dysfunction (29.7% vs. 19.4%; P < 0.01) and galactorrhea (11.1% vs. 2.1%; P < 0.01). Patients with lactotroph disinhibition were more likely to harbor macroadenomas than were patients who did not show lactotroph disinhibition (81.9% vs. 70.2%; P= 0.06). Among patients with increased preoperative prolactin, 77.8% experienced normalization of serum prolactin postoperatively, galactorrhea improved in 100%, sexual dysfunction resolved in 66.6%, and menstrual dysfunction among premenopausal females normalized in 73.3% at last follow-up (mean, 5.35years; range, 0.1-10 years). Transsphenoidal surgery can provide durable normalization of serum prolactin levels and related symptoms caused by pituitary stalk compression-related lactotroph disinhibition.

Short-term low-protein diet during pregnancy alters islet area and protein content of phosphatidylinositol 3-kinase pathway in rats.

The phosphatidylinositol 3-kinase and mitogen-activated protein kinase pathways mediate β cell growth, proliferation, survival and death. We investigated whether protein restriction during pregnancy alters islet morphometry or the expression and phosphorylation of several proteins involved in the phosphatidylinositol 3-kinase and mitogen-activated protein kinase pathways. As controls, adult pregnant and non-pregnant rats were fed a normal-protein diet (17%). Pregnant and non-pregnant rats in the experimental groups were fed a low-protein diet (6%) for 15 days. Low protein diet during pregnancy increased serum prolactin level, reduced serum corticosterone concentration and the expression of both protein kinase B/AKT1 (AKT1) and p70 ribosomal protein S6 kinase (p70S6K), as well as the islets area, but did not alter the insulin content of pancreatic islets. Pregnancy increased the expression of the Src homology/collagen (SHC) protein and the extracellular signal-regulated kinases 1/2 (ERK1/2) independent of diet. ERK1/2 phosphorylation (pERK1/2) was similar in islets from pregnant and non-pregnant rats fed a low-protein diet, and was higher in islets from pregnant rats than in islets from non-pregnant rats fed a normal-protein diet. Thus, a short-term, low-protein diet during pregnancy was sufficient to reduce the levels of proteins in the phosphatidylinositol 3-kinase pathway and affect islet morphometry.

Kadın hastalarda risperidon ve paliperidonun serum prolaktin düzeyleri üzerine kısa dönem etkilerinin karşılaştırılması

Objective: Hyperprolactinemia is an adverse effect, which is related with the use of antipsychotics. All typical antipsychotics are considered to increase serum prolactin levels. Compared with typical antipsychotics, most of the atypical antipsychotics have a reduced tendency for increasing serum prolactin levels. However, effects of all atypical antipsychotics on serum prolactin levels are not always similar. In the present study, we aimed to compare short-term effects of risperidone and paliperidone, which are two similar atypical antipsychotics in terms of hyperprolactinemia and its associated symptoms. Methods: In this study, we screened data of female patients with diagnosis of schizophrenia and other psychotic disorders, bipolar disorder and who were treated with risperidone or paliperidone. The patients who had adequate sociodemographical and clinical data and who had screened in terms of prolactin levels before and fourth week of the treatment were included to study. Results: Forty-two patients have been treated with risperidone and 36 patients have been treated with paliperidone. Treatment groups were similar in terms of sociodemographic variables. The mean values of serum prolactin levels were significantly increased after four weeks of treatment in both groups (pl0.001). The discontinuation rates because of menstrual irregularities, galactorrhea, sexual dysfunction in risperidone and paliperidone groups were 11.9% and 30.6% respectively, and the rate was significantly higher in paliperidone group (?2=4.13, p=0.04). Conclusion: We suggest that beside its benefits and some superiorities compared to risperidone, paliperidone has no advantage over risperidone in terms of hyperprolactinemia and its associated symptoms. We also suggest that female patients should be monitorized regulary in terms of hyperprolactinemia and its associated symptoms while they are being treated with paliperidone. To our knowledge, the present study is the first to compare and demonstrate the effects of paliperidone and risperidone on serum prolactin levels in Turkey. Further studies with larger sample size are needed to highlight the short term and long term effects of paliperidone on serum prolactin levels in female patients.

Moringa oleifera as a Galactagogue.

Moringa is an herbal galactagogue that has been widely used in the Philippines and some parts of the world. Recent systematic reviews on herbal galactagogues have appraised the use of several herbs but failed to include Moringa. Dr. E. Quisumbing was the first scientist in the Philippines to do a study on its lactogenic properties in 1987. In 1996, Yabes-Almirante and Lim further determined a causal relationship of Moringa capsule intake with increased milk production by demonstrating increased serum prolactin levels. We conducted an update on a previously published systematic review on the use of Moringa compared with placebo in increasing breastmilk production, infant’s weight gain, serum prolactin levels, success of exclusive breastmilk production, and adverse effects. Thirty-three titles and abstracts were retrieved from electronic databases (Medline, HERDIN, Scopus, and Google Scholar), hand searching, and reference tracking. The literature search was limited to human clinical trials using the search terms ‘‘Moringa oleifera,’’ ‘‘Moringa pterygosperma,’’ ‘‘Moringa,’’ ‘‘drumstick tree,’’ ‘‘horseradish tree,’’ and ‘‘Ben oil tree.’’ Six randomized, placebo-controlled, blinded, clinical trials were included in the analyses, five of which were published in the Philippines. All studies were done among Filipinos. Two were done in a community, and four were done in tertiary hospitals. Pooling of studies revealed a significant mean increase in milk volume on Day 7 (Fig. 1) among mothers who received Moringa by 124 mL (95% confidence interval, 90–159 mL; heterogeneity I = 0%; p = 0.32). Milk volume on Days 4 and 5 also favored the Moringa group as well, but the comparison showed significant heterogeneity, probably because of differences in postnatal age of infant, timing of breastmilk collection, and maternal age difference. Of particular interest is the difference in study designs between preterm and term infants. Milk collection for preterm infants involved breastmilk expression either by hand or by machine, and the infants were fed through gavage. For term infants, on the other hand, milk expression and measurement of outcome were done after breastfeeding. This resulted to measurement of residual volume after initial emptying by the baby. The reported milk volume for term infants may therefore be an underestimate. Pooled analysis of the two studies with a total of 73 patients showed a significant increase in the weight of infants during week 4 with a mean difference of 11.9% (95% confidence interval, 5.5–18.2%; heterogeneity I = 0%; p= 0.61), which favors the experimental group. The lactogenic effect of Moringa is hypothesized to be the induction of prolactin production in the anterior pituitary gland. The two studies (Fig. 2) that reported on prolactin levels showed that patients in the Moringa group had higher levels with a statistically significant mean increase of 19.5 · 10 mIU/L (95% confidence interval, 16.8–22.2 · 10 mIU/L; heterogeneity I = 44%; p = 0.18). Timing of outcome measurement is indeed an important variable because growth of infants is dependent on their postnatal age, and prolactin serum levels have varying levels across postpartum days. Safety profile was merely obtained through self-report, of which no adverse event was seen among the six studies. There were no studies that investigated exclusive breastfeeding as an outcome. Overall, these six randomized controlled trials suggest that Moringa can result in a significant increase in breastmilk volume on Day 7. It also results in improvement in the infants’ weight gain. This herbal galactagogue also shows a

Serum prolactin in advanced chronic liver disease.

Hyperprolactinemia is a frequent endocrine disorder with well known harmful effects on the reproductive system and bone metabolism. Besides prolactinomas several drugs and disorders such as renal failure and hypothyroidism have been shown to cause hyperprolactinemia. Based on former studies, liver cirrhosis has also been suggested to cause hyperprolactinemia, while mechanisms have not been identified yet. In this study, we set out to investigate the prevalence and predictors of hyperprolactinemia in 178 patients with liver cirrhosis of different etio-logies. Eighteen out of 178 patients - 7 females and 11 males - displayed elevated serum pro-lactin levels. When patients were excluded who suffered from co-morbidities or took medication that are discussed to potentially interfere with prolactin metabolism, only 3 males displayed increased serum prolactin levels. Prolactin levels were similar in patients with liver cirrhosis of different etiologies. Our data suggest that hyperprolactinemia is not commonly found in patients with liver cirrhosis, but is mostly associated with intake of drugs or presence of comorbidites which are known to potentially cause hyperprolactinemia. We thus hypothesize that in contrast to former studies liver cirrhosis is not a common cause of hyperprolactinemia and that in the absence of co-morbidities or drugs that are known to potentially increase prolactin levels, marked hyperprolactinemia needs further investigation in patients with liver cirrhosis.

Involvement of dopamine D2 receptor in the diurnal changes of tuberoinfundibular dopaminergic neuron activity and prolactin secretion in female rats.

BackgroundAn endogenous dopaminergic (DA) tone acting on D3 receptors has been shown to inhibit tuberoinfundibular (TI) DA neuron activity and stimulate prolactin (PRL) surge in the afternoon of estrogen-primed ovariectomized (OVX+E2) rats. Whether D2 receptor (D2R) is also involved in the regulation of TIDA and PRL rhythms was determined in this study.ResultsIntracerebroventricular (icv) injection of PHNO, a D2R agonist, in the morning inhibited TIDA and midbrain DA neurons’ activities, and stimulated PRL secretion. The effects of PHNO were significantly reversed by co-administration of raclopride, a D2R antagonist. A single injection of raclopride at 1200 h significantly reversed the lowered TIDA neuron activity and the increased serum PRL level at 1500 h. Dopamine D2R mRNA expression in medial basal hypothalamus (MBH) exhibited a diurnal rhythm, i.e., low in the morning and high in the afternoon, which was opposite to that of TIDA neuron activity. The D2R rhythm was abolished in OVX+E2 rats kept under constant lighting but not in OVX rats with regular lighting exposures. Pretreatment with an antisense oligodeoxynucleotides (AODN, 10 μg/3 μl/day, icv) against D2R mRNA for 2 days significantly reduced D2R mRNAs in central DA neurons, and reversed both lowered TIDA neuron activity and increased serum PRL level in the afternoon on day 3. A diurnal rhythm of D2R mRNA expression was also observed in midbrain DA neurons and the rhythm was significantly knocked down by the AODN pretreatment.ConclusionsWe conclude that a diurnal change of D2R mRNA expression in MBH may underlie the diurnal rhythms of TIDA neuron activity and PRL secretion in OVX+E2 rats.

Serum prolactin in advanced chronic liver disease

Hyperprolactinemia is a frequent endocrine disorder with well known harmful effects on the reproductive system and bone metabolism. Besides prolactinomas several drugs and disorders such as renal failure and hypothyroidism have been shown to cause hyperprolactinemia. Based on former studies, liver cirrhosis has also been suggested to cause hyperprolactinemia, while mechanisms have not been identified yet. In this study, we set out to investigate the prevalence and predictors of hyperprolactinemia in 178 patients with liver cirrhosis of different etio­logies. Eighteen out of 178 patients – 7 females and 11 males – displayed elevated serum pro­lactin levels. When patients were excluded who suffered from co-morbidities or took medication that are discussed to potentially interfere with prolactin metabolism, only 3 males displayed increased serum prolactin levels. Prolactin levels were similar in patients with liver cirrhosis of different etiologies. Our data suggest that hyperprolactinemia is not commonly found in patients with liver cirrhosis, but is mostly associated with intake of drugs or presence of comorbidites which are known to potentially cause hyperprolactinemia. We thus hypothesize that in contrast to former studies liver cirrhosis is not a common cause of hyperprolactinemia and that in the absence of co-morbidities or drugs that are known to potentially increase prolactin levels, marked hyperprolactinemia needs further investigation in patients with liver cirrhosis.

Comparison of short term effects of risperidone and paliperidone on serum prolactin levels in female patients

Objective: Hyperprolactinemia is an adverse effect, which is related with the use of antipsychotics. All typical antipsychotics are considered to increase serum prolactin levels. Compared with typical antipsychotics, most of the atypical antipsychotics have a reduced tendency for increasing serum prolactin levels. However, effects of all atypical antipsychotics on serum prolactin levels are not always similar. In the present study, we aimed to compare short-term effects of risperidone and paliperidone, which are two similar atypical antipsychotics in terms of hyperprolactinemia and its associated symptoms. Methods: In this study, we screened data of female patients with diagnosis of schizophrenia and other psychotic disorders, bipolar disorder and who were treated with risperidone or paliperidone. The patients who had adequate sociodemographical and clinical data and who had screened in terms of prolactin levels before and fourth week of the treatment were included to study. Results: Forty-two patients have been treated with risperidone and 36 patients have been treated with paliperidone. Treatment groups were similar in terms of sociodemographic variables. The mean values of serum prolactin levels were significantly increased after four weeks of treatment in both groups (p