Management Of Hyperprolactinemia Research Articles

The research trend of hyperprolactinemia from 2011 to 2023 was analyzed by bibliometrics.

The objective of this study is to conduct a bibliometric analysis of research trends in hyperprolactinemia from 2011 to 2023. This analysis aims to provide researchers with insights into the current hotspots and frontiers related to hyperprolactinemia. It is worth noting that there are currently no existing reports on bibliometric analyses of hyperprolactinemia. The Social Science Citation Index (SSCI) and Science Citation Index Expanded (SCIE) databases of the Web of Science Core Collection were systematically searched for "articles" and "review articles" related to the topic of hyperprolactinemia from 2011 to 2023. VOSviewer was employed to conduct bibliometric analysis, aiming to analyze the research trends in hyperprolactinemia over the past 13 years. A total of 1865 eligible articles were retrieved, with contributions from 9544 scholars representing 83 countries in the field of research. The United States had the highest number of publications, followed by China. The keywords were categorized into six clusters: (1) etiology of hyperprolactinemia and other related endocrine and metabolic diseases. (2) Hyperprolactinemia and mental illness. (3) Diagnosis and management of hyperprolactinemia. (4) Treatment of hyperprolactinemia and prolactinoma. (5) Detection of macroprolactin and macroprolactinemia. (6) Symptoms of male hyperprolactinemia. Over the past 13 years, there has been a consistent and slightly increasing trend in the number of research papers focusing on hyperprolactinemia. The primary areas of research focus are centered around the diagnosis and treatment of hyperprolactinemia caused by antipsychotic drugs or prolactinoma.

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

Macroprolactinoma in a 14-Year-Old Girl in the Northeast of Iran: A Case Report

ABstractProlactinoma is frequently found not only in females but also in males with abnormal reproductive and/or sexual function. Patients typically complain about amenorrhea and infertility because of anovulation. Approximately 15% to 20% of cases of secondary amenorrhea are caused by prolactinemia. Galactorrhea may occur simultaneously, before or after menstrual disorders, and sometimes it may not be clinically obvious, or only detected by breast examination. We reported a case of a 14-year-old girl who presented primary amenorrhea accompanied by frequent headaches and blurred vision. Hormonal tests showed severe hyperprolactinemia (prolactin [PRL] concentration: 1,570 ng/ml). Further tests confirmed a mass in the pituitary with an extension to the left parasellar and suprasellar regions. Some parts of the sella turcica tumor were removed by transcranial surgery. During the follow-up, the clinicopathological examinations revealed the patient had hyperprolactinemia. Clinicians should be aware of the diagnostic and therapeutic problems regarding the management of hyperprolactinemia.

Management of Hyperprolactinemia in Clinical Practice

Background & objectives: Hyperprolactinemia is defined as an increased prolactin level above the normal reference range, in women more than 25 ng/dl; with a prevalence rate of 10% in the general population. Hyperprolactinemia is associated with different clinical presentations various from oligomenorrhea, amenorrhea, galactorrhea, and infertility. This study aims to be to assess the current practice regarding the management of hyperprolactinemia in non-pregnant women in the Kurdistan region, Iraq. Subjects and Methods: An electronic questionnaire on current practice concerning diagnosis and treatment of hyperprolactinemia in non-pregnant women was sent through e-mail to 167 clinicians, 166 of them completed the survey and they were from different cities (Duhok, Sulaymaniyah, Erbil, and Halabja) of the Kurdistan region, Iraq. Results: A total of 166 valid questionnaires were collected. The response received from 166 clinicians. Almost 97 % of the responders were asking about the presence of symptoms of prolactinoma in patients with hyperprolactinemia and the majority of responders were made an exclusion of physiological causes related to hyperprolactinemia. When hyperprolactinemia occurred, only 81.3% of the respondents would test for thyroid-stimulating hormone routinely. Majority of the responders (79.5%) did not confirm the biochemical diagnosis of hyperprolactinemia before starting treatment and only two-thirds of them do pituitary imaging. Also, our results show an important role of clinician’s characteristics like age group on the management outcome, as the age group 25-35 was better when compared to the age group 46-55 (p-value =0.044) and the internist specialty and family medicine specialty have a better impact on management outcome in comparison to endocrinologist with (p-value =0.046 and 0.043 respectively). Conclusions: We found that the current clinical practice for the management of hyperprolactinemia is not uniform with some scientific defects. Therefore, it is necessary to develop national guidelines for the management and treatment of hyperprolactinemia.

Hyperprolactinemia as a side effect of using antipsychotics In Schizophrenic Patients

Introductions: Antipsychotics are still the mainstay of schizophrenia management. Antipsychotics are antagonistic to postsynaptic dopamine receptors in the brain. Blockade of dopamine receptors in the tuberoinfundibular pathway by antipsychotics will cause the side effect of hyperprolactinemia. Objectives: This review describes hyperprolactinemia induced by antipsychotic use and its clinical effects, monitoring, and management. Methods: reference search through Google Scholar with keywords schizophrenia, antipsychotics, prolactin, hyperprolactinemia, clinical effects of hyperprolactinemia, diagnosis of hyperprolactinemia, monitoring of hyperprolactinemia, management of hyperprolactinemia. Results: Clinicians need to take a diagnostic approach to identify the etiology of hyperprolactinemia, monitor the clinical symptoms of hyperprolactinemia during the administration of antipsychotics, and immediately carry out management according to existing strategies by considering some general principles and considerations. Conclusions: Schizophrenia is a severe mental disorder that lasts long, requiring long-term and continuous therapy. Administration of antipsychotics is still a mainstay in the management of schizophrenia. Antipsychotics are antagonists to postsynaptic dopamine receptors in the brain. The antipsychotic effect of blocking dopamine receptors not only improves the symptoms of schizophrenia but also causes side effects. The side effect when the tuberoinfundibular dopamine pathway is blocked is an increase in prolactin levels called hyperprolactinemia.

Current and Perspective Approaches to the Treatment of Prolactinomas.

Along with the presence of the 2011 Endocrine Society Clinical Practice Guidelines and numerous large-scale studies on the treatment of hyperprolactinemia of different origin, there are some unresolved questions, ambiguous and sometimes contradictory points of view regarding the management of patients with prolactinomas. This overview is devoted to the analysis of the results of modern clinical studies and the approaches towards the management of hyperprolactinemia caused by prolactinoma. A systematic research of the literature for the appropriate keywords published mainly for the last 10 years was done; also, a reference list of each selected article was analysed. We included to our review the articles reporting controversial issues or new data on the treatment of hyperprolactinemia. The review describes various problems arising during the treatment of prolactinoma. The presence of primary and secondary dopamine agonist resistance in each case requires an individual approach, and sometimes may include the use of the antineoplastic agent t emozolomide. The side effects of dopamine agonists are discussed, with quite rare ones, including valvulopathy, pathological psychological conditions and cerebrospinal rhinorrhea. The controversial issue of the duration and doses of the drug used to achieve a lasting effect in the treatment of prolactinomas is considered. There are some points connected with the frequency of relapses. Thus, recurrence is correlated to the duration of treatment with dopamine agonists, prolactin levels at diagnosis, and the initial tumor size. Metformin, somatostatin analogues, selective estrogen receptor modulators, tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, epidermal growth factor receptor antagonists are investigated nowadays as potential alternative methods of drug treatment of prolactinomas. Drug therapy with dopamine agonists makes it possible to achieve the desired results in the vast majority of patients. However, despite the proven safety of this group of medicines, the risk of side effects should still be taken into account. The therapy regimen should be determined by the clinical course of prolactinoma and the patient's response to treatment. Other options of treatment should be considered in patients intolerant to medical therapy, with contraindication or resistance to dopamine agonists, in the case of a malignant tumor. The presence of refractory to any of the applied methods of treatment and aggressive prolactinomas leads to the search for new drugs.

Diagnosis and Management of Hyperprolactinemia

Diagnosis and Management of Hyperprolactinemia

Diagnosis and Management of Hyperprolactinemia

Diagnosis and Management of Hyperprolactinemia

An Audit on the Monitoring and Management of Hyperprolactinemia in Inpatient Adults on Regular Antipsychotics in 8 Acute Wards in an NHS Mental Health Trust

AimsThe aim of the audit is to ascertain how well hyperprolactinemia is being monitored and managed across all acute adult inpatient wards in a mental health NHS Trust, for patients on regular antipsychotic mediation. The objectives of the audit are to: 1) Assess whether prolactin is being monitored according to local guidelines for patients on regular antipsychotic medication, 2) Determine whether hyperprolactinemia is being identified and managed according to appropriate guidelines, 3) Assess the standard of documentation around the decisions made.MethodsData were collected retrospectively from the electronic notes and records for 78 patients, who were discharged from 8 acute wards in February 2021. For checking prolactin test results, the relevant reporting systems were accessed. Two data collection forms were used, which separated patients between those already taking antipsychotics prior to their admission and those who were newly initiated on an antipsychotic.Patients who were prescribed at least one regular antipsychotic were included. Patients with pre-existing medical conditions that cause hyperprolactinaemia, ongoing pregnancy or breastfeeding were excluded. The monitoring for and management of hyperprolactinaemia was assessed against NICE and local guidance.ResultsFrom the reviewed data, 41 patients were prescribed at least one regular antipsychotic drug during their admission. 32 patients were already established on an antipsychotic prior to their admission and 9 individuals were started on their first antipsychotic. Hyperprolactinaemia was identified in 9 patients. 19 patients had no prolactin assay performed during their whole admission.44.4% of antipsychotic naïve patients had a baseline prolactin level taken prior to starting an antipsychotic. 9.1% of patients with hyperprolactinaemia had their symptoms assessed by a clinician. 27.3% of patients with hyperprolactinaemia had actions discussed and undertaken to address this.ConclusionThis audit identified that patients are at risk of suffering from hyperprolactinaemia and are being insufficiently monitored. The symptoms of hyperprolactinaemia are not adequately screened or assessed for. This may increase the side effect burden and decrease medication adherence among patients. There is a need to increase the awareness among clinicians about the importance of regular prolactin monitoring to improve patient outcomes.

Nurse's role in the management of hyperprolactinemia: a prospective randomized controlled trial

Nurse's role in the management of hyperprolactinemia: a prospective randomized controlled trial

Understanding the Limitations of the Odds Ratio in a Case-Control Study of the Association Between Breast Cancer and Exposure to Antipsychotic Drugs

Evidence suggests that women with schizophrenia are less likely to be screened for breast cancer, more likely to suffer from breast cancer, and more likely to die of breast cancer than women without schizophrenia or general population controls. Antipsychotic drugs, and especially prolactin-raising antipsychotic drugs, have been suggested to increase the breast cancer risk, but the evidence has so far been inconclusive. Against this background, a recent, large, nationwide, case-control study in Finland examined the odds of previous prolonged exposure to prolactin-raising and prolactin-sparing antipsychotic drugs in women with schizophrenia who were (cases) versus were not (controls) diagnosed with breast cancer. The study found that, relative to < 1 year of antipsychotic exposure, breast cancer was associated with significantly increased odds of previous, prolonged (> 5 years) exposure to prolactin-raising antipsychotics. The associations were not statistically significant for prolactin-sparing antipsychotics. The study is critically examined from the perspective of interpretation of the odds ratio and its limitations in order to help readers understand how to better evaluate and generalize findings in case-control studies. This is necessary because results in case-control studies are often incorrectly interpreted, and the limitations of the odds ratios derived in such studies are often not recognized. It is concluded that the design and findings of the reviewed study could not allow readers to judge whether or not prolactin-sparing antipsychotics are associated with lower breast cancer risk than prolactin-raising antipsychotics. In contexts other than breast cancer risk, adverse consequences associated with prolactin elevation are well known, and avoidance or management of hyperprolactinemia is therefore desirable.

Nurse's Role in the Management of Hyperprolactinemia

Nurse's Role in the Management of Hyperprolactinemia

Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology

This is a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology on the role of echocardiography in monitoring patients receiving dopamine agonist (DA) therapy for hyperprolactinaemia. (1) Evidence that DA pharmacotherapy causes abnormal valve morphology and dysfunction at doses used in the management of hyperprolactinaemia is extremely limited. Evidence of clinically significant valve pathology is absent, except for isolated case reports around which questions remain. (2) Attributing change in degree of valvular regurgitation, especially in mild and moderate tricuspid regurgitation, to adverse effects of DA in hyperprolactinaemia should be avoided if there are no associated pathological changes in leaflet thickness, restriction or retraction. It must be noted that even where morphological change in leaflet structure and function may be suspected, grading is semi-quantitative on echocardiography and may vary between different machines, ultrasound settings and operators. (3) Decisions regarding discontinuation of medication should only be made after review of serial imaging by an echocardiographer experienced in analysing drug-induced valvulopathy or carcinoid heart disease. (4) A standard transthoracic echocardiogram should be performed before a patient starts DA therapy for hyperprolactinaemia. Repeat transthoracic echocardiography should then be performed at 5 years after starting cabergoline in patients taking a total weekly dose less than or equal to 2 mg. If there has been no change on the 5-year scan, repeat echocardiography could continue at 5-yearly intervals. If a patient is taking more than a total weekly dose of 2 mg, then annual echocardiography is recommended.

Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: A joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology.

This is a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology on the role of echocardiography in monitoring patients receiving dopamine agonist (DA) therapy for hyperprolactinaemia. Evidence that DA pharmacotherapy causes abnormal valve morphology and dysfunction at doses used in the management of hyperprolactinaemia is extremely limited. Evidence of clinically significant valve pathology is absent, except for isolated case reports around which questions remain. Attributing change in degree of valvar regurgitation, especially in mild and moderate tricuspid regurgitation, to adverse effects of DA in hyperprolactinaemia should be avoided if there are no associated pathological changes in leaflet thickness, restriction or retraction. Note must be taken that even where morphological change in leaflet structure and function may be suspected, grading is semi-quantitative on echocardiography and may vary between different machines, ultrasound settings and operators. Decisions regarding discontinuation of medication should only be made after review of serial imaging by an echocardiographer experienced in analysing drug-induced valvulopathy or carcinoid heart disease. A standard transthoracic echocardiogram should be performed before a patient starts DA therapy for hyperprolactinaemia. Repeat transthoracic echocardiography should then be performed at 5years after starting cabergoline in patients taking a total weekly dose less than or equal to 2mg. If there has been no change on the 5-year scan, repeat echocardiography could continue at 5-yearly intervals. If a patient is taking more than a total weekly dose of 2mg, then annual echocardiography is recommended.

Clinical manifestations, evaluation and management of hyperprolactinemia in adolescent and young girls: a brief review.

Hyperprolactinemia (HPrl) is considered as a rare endocrinopathy in childhood. In children and adolescent girls, there are three major categories of HPrl causes; physiological, pathological and iatrogenic. Through hypogonadotropic hypogonadism, prolactin hypersecretion and production leads to the typical functional syndrome which is observed in female children and adolescents; delayed puberty, primary or secondary amenorrhea and/or galactorrhea. Regarding prolactinomas, clinical signs manifest with mass compression of the optic chiasm and anterior pituitary gland or prolactin hypersecretion. Targeted identification of HPrl is of significant importance for proper management and follow-up. The aim of this review is to focus on the evaluation of HPrl in adolescent and young girls. In addition, we aimed to summarize the current knowledge regarding the proper management of such cases. (www.actabiomedica.it)

Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism.

Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

Management of Hyperprolactinaemia in Gynaecological Practice in Blackpool, United Kingdom, a Study of Earlier Experience, with a Review of Relevant Literature

Aim and Objectives: The primary aims of this study were to find out the number of patients (prevalence and incidence) who presented for the first time during the three year period of 2000 to 2002, under review, with hyperprolactinaemia; to assess if their management conformed to any evidence based plan or defined local protocol and whether their management influenced outcome following management. The secondary aim was to formulate a framework template for a protocol on management of patients with hyperprolactinaemia. Such a framework would be used for future audits or reviews on the same subject matter, since this was the first ‘audit’ or review of its kind in the Unit.

Monitoring of prolactin levels in children and adolescents prescribed antipsychotic medication: a complete audit cycle.

Basal determinations of serum prolactin improved significantly at the end of the audit cycle (28.6% v. 57%) with slight improvement in six monthly repeat prolactin monitoring (28.6% v. 39.1%) showing some change in clinical practice. However, there was minimal improvement in managing hyperprolactinaemia (0% v. 12.5%). Clinical implication There is growing awareness about hyperprolactinaemia associated with the use of antipsychotic medication in children and adolescents and the long-term effects. Clear documented guidelines will help increase and improve the monitoring and management of hyperprolactinaemia in these groups of patients. However, more needs to be done in improving the practice of monitoring and managing hyperprolactinaemia in children and adolescent prescribed antipsychotic medication giving the documented long-term effects.

Hyperprolactinaemia and psychotropics: endocrine effects and treatment.

Hyperprolactinaemia is a common endocrine abnormality. Causes are multifactorial. Medication use contributes a considerable amount, with psychotropics often implicated, although underlying hypothalamic–pituitary pathology can co-exist. This article discusses the management of hyperprolactinaemia during psychotropic use.

Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia

Abstract Objective To provide practical and up-to-date recommendations for evaluation, differential diagnosis, and treatment of prolactinoma and hyperprolactinemia in various clinical settings. Participants Members of the Neuroendocrinology Working Group of the Spanish Society of Endocrinology. Methods Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system (GRADE) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in Medline (Pubmed) for each subject, and authors’ considerations were added in areas where the literature provided scarce evidence. Finally, recommendations were jointly discussed by the Working Group. Conclusions The document provides evidence-based practical and updated recommendations for diagnosis and management of hyperprolactinemia and prolactinoma, including drug-induced hyperprolactinemia, treatment options for prolactinoma (drugs, surgery, and radiotherapy), prolactinoma in pregnancy, adverse effects of dopaminergic agents, and drug-resistant and malignant prolactinomas.