Prolactin Concentrations In Patients Research Articles

Serum Prolactin Concentration in Patients with Pemphigus Vulgaris

Background: Pemphigus vulgaris (PV) is an autoimmune bullous disorder characterized clinically by blisters and erosions of the skin and/or mucous membranes. Serum prolactin plays a role in the pathogenesis of pemphigus vulgaris. Objective: The study aims to observe the serum prolactin concentration in patients with pemphigus vulgaris. Methods: This cross-sectional study was conducted at the Department of Dermatology & Venereology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between May 2017 and April 2018. A total of 35 patients were included in the study. A consecutive type of sampling technique was used. The dermatological examination was done to ascertain the extent of involvement of the disease. Results: Among 35 patients, 31.4% belonged to 30-50 years age group, while 62.9% belonged to >50 years and 5.7% patients belonged to <30 years ae group. The mean age was found 42.7±11.8 years with ranged from 19-65 years. The majority of the patients (57.1%) were male, and 42.9% patients were female. It was observed that 30(85.7%) had vesicles, 25(71.4%) had bulla, 35(100%) had erosions and 6(17.1%) had other types of lesions. 28 patients (80.0%) had scalp, 32(91.4%) had extremity, 35(100.0%) had trunk and 31(88.6%) had mucous membrane as the sites of involvement. The mean duration of disease was 9.0±12.7 months with a range from 0.5 to 36 months. It was observed that 9 patients (25.7%) had hyperprolactinemia, while 26 patients (74.3%) had normal levels of prolactin. The mean serum prolactin level was found 28.7±16.7 ng/ml with a range from 1.64 to 51.04 ng/ml. Conclusion: Since serum prolactin plays a role in the pathogenesis of pemphigus vulgaris, it may offer a novel therapeutic target for treatment of PV. Thus, we may reduce morbidity and mortality rate in PV patients by modifying their serum prolactin levels. Mugda Med Coll J. 2023; 6(1): 20-24

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

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

Prolactin gene polymorphism (− 1149 G/T) is associated with hyperprolactinemia in patients with schizophrenia treated with antipsychotics

BackgroundAntipsychotic drugs can cause hyperprolactinemia. However, hyperprolactinemia was also observed in treatment-naive patients with a first schizophrenic episode. This phenomenon might be related to the role of prolactin as a cytokine in autoimmune diseases. Extrapituitary prolactin production is regulated by an alternative promoter, which contains the functional single nucleotide polymorphism −1149 G/T (rs1341239). We examined whether this polymorphism was associated with hyperprolactinemia in patients with schizophrenia. MethodWe recruited 443 patients with schizophrenia and 126 healthy controls. The functional polymorphism −1149 G/T (rs1341239) in the prolactin gene was genotyped with multiplexed primer extension, combined with MALDI-TOF mass spectrometry. Genotype and allele frequencies were compared between groups with the χ2 test and logistic regression models adjusting for covariates. ResultsThe frequency of genotypes and alleles in patients with schizophrenia did not differ from those in control subjects. A comparison between patients with schizophrenia with and without hyperprolactinemia revealed significantly higher frequency of the G allele in patients with hyperprolactinemia than in patients without it (χ2=7.25; p=0.007; OR=1.44 [1.10–1.89]). Accordingly, patients with hyperprolactinemia carried the GG genotype more frequently than patients without hyperprolactinemia (χ2=9.49; p=0.009). This association remained significant after adjusting the estimates for such covariates as sex, age, duration of the diseases and the dose of chlorpromazine equivalents. ConclusionThis study revealed a significant association between the polymorphic variant rs1341239 and the development of hyperprolactinemia in patients with schizophrenia. The serum prolactin concentration in patients with schizophrenia treated with antipsychotics may provide an indication of the activity of the gene that regulates extrapituitary prolactin production which is believed to play a role in the immune system.

The Role of Prolactin– and Endometriosis-Associated Infertility

This review will address the current understanding of the relationship between prolactin (PRL) and endometriosis-associated infertility. Although the exact mechanisms of action of hyperprolactinemia in patients with endometriosis-associated infertility have not been clearly established, this report reviews results from relevant studies in the literature. These include serum PRL levels in endometriosis-associated infertility, PRL receptors in ectopic endometriotic tissues, basal PRL levels after TSH and Danazol (isoxazolic derivative of the synthetic steroid 5alpha-ethinyl-testosterone) therapy, peritoneal fluid and nocturnal serum PRL levels in endometriosis, infertility, and luteal phase PRL concentrations in patients with endometriosis. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to explain the relationship between prolactin- and endometriosis-associated infertility, relate endometriosis with infertility, and summarize two ways in which prolactin and endometriosis may be linked in the pathophysiology of infertility.

Pre-operative dopamine agonist therapy improves post-operative tumor control following prolactinoma resection

Normalization of serum prolactin concentrations in patients with prolactinomas is an accepted endpoint of therapy. Clinical signs and symptoms of hyperprolactinemia are usually resolved when prolactin levels are lowered to within the normal range. While most patients are treated with dopamine agonist drugs, some patients require surgical resection of their tumors. We sought to determine whether preoperative treatment with dopamine agonists alters the outcome of surgical intervention. We present an analysis of 253 patients with prolactinomas treated surgically during the period of time when dopamine agonist therapy was first introduced and prior to its widespread use as first-line therapy. We compared both short- and long-term outcomes of patients treated with dopamine agonists prior to surgery with those undergoing surgery as their initial treatment modality. Our data showed that that patients treated with dopamine agonists prior to surgery experienced greater reductions in prolactin levels, had lower prolactin levels, were more likely to have normal prolactin levels at long term follow-up, and were less likely to require additional therapy to control their prolactin levels. Our study provides strong evidence suggesting that, regardless of initial prolactin level, preoperative dopamine agonist therapy is not detrimental. In fact, pretreatment with dopamine agonist drugs, possibly by inducing tumor regression, seemed to improve the surgeon's ability to resect a greater percentage of the tumor and led to better control of the prolactin level.

Effect of therapy with atypical antipsychotic drugs on prolactin concentration in patients with schizophrenia and schizoaffective disorders

Plasma prolactin concentration was measured in patients with schizophrenia and schizoaffective disorders receiving therapy with risperidone, olanzapine, and quetiapine and compared with the corresponding parameter in patient receiving typical neuroleptic drug haloperidol. We evaluated the specific effects of the test drugs on prolactin concentration in men and women.

Serum free prolactin concentrations in patients with systemic lupus erythematosus are associated with lupus activity

To determine in patients with systemic lupus erythematosus (SLE) the relationships among serum total and free prolactin (PRL) levels, isoforms of PRL and lupus activity. In a cross-sectional study, 259 patients with SLE were tested for serum total PRL, serum free PRL, and PRL in fractions obtained after gel filtration chromatography (in 70 sera taken at random) by immunoradiometric assay based on disease activity. A significant correlation between direct PRL and free PRL levels was found in patients with and without lupus activity (r = 0.475, P<0.001); however, this was less so for non-active patients than for active patients (r=0.433, P<0.001 and r=0.909, P<0.001, respectively). SLE Disease Activity Index (SLEDAI) scores correlated positively with serum free PRL levels (r=0.314, P<0.001) and percentage of little PRL (r=0.33, P=0.005) and negatively with percentage of big big PRL (r=-0.3, P=0.012). Patients with active disease had higher serum free PRL levels (median 12.6 vs 9.3 ng/ml, P<0.001), higher percentages of little PRL (83.1 +/- 21.2 vs 63.6 +/- 24.8%, P=0.011) and lower percentages of big big PRL (9.4 +/- 18.0 vs 25.2 +/- 24.3%, P=0.031). Different clinical manifestations and serological parameters of lupus disease activity were more frequent in patients with free hyperprolactinaemia than in patients with normal serum free PRL levels (such as neurological manifestations, renal involvement, serositis, haematological manifestations, anti-double-stranded DNA and hypocomplementaemia; P<0.021). An increase in serum free PRL levels, higher percentages of little PRL and lower percentages of big big PRL proved to be factors related to lupus activity in a subset of patients with SLE. These novel data must be taken into account in future studies aiming to establish a relationship between PRL and disease activity in SLE.

Serum prolactin concentrations in patients infected with human immunodeficiency virus

PURPOSE: To analyze the prevalence, effects of HAART, and implications of hyperprolactinemia in HIV-infected patients. METHOD: 192 HIV-infected men in stable clinical condition who underwent 355 measurements of prolactin were prospectively studied. Other clinical, immunologic, virologic, and laboratory parameters were also evaluated at the time of each prolactin measurement. RESULTS: Hyperprolactinemia was observed in 21.4% of the patients. Hyperprolactinemia was more commonly found in patients receiving opioids than in those who were not (p = .03), but it was not influenced by a past diagnosis of AIDS, presence of metabolic disturbances, gynecomastia, or viral load. Patients noninfected with hepatotropic viruses had slightly higher prolactin levels than those who were infected (p = .049). There were significant differences in the rates of hyperprolactinemia according to different CD4 strata, with higher rates in patients with higher CD4 counts. Similarly, hyperprolactinemic patients had higher CD4 counts than patients with normal prolactin (p = .038). Antiretroviral therapy was not associated with prolactin levels. CONCLUSION: Hyperprolactinemia is a common finding in HIV infection and is observed in about one fifth of male patients in stable clinical condition. It is not related to antiretroviral therapy, metabolic disturbances, liver disease, or viral load. The implications of its association with CD4 counts are unclear and should be investigated.

Evaluation of Serum ProlactinLevels in Patients with Endometriosisand Infertility

The aim of this study was to clarify the significance of serum prolactin concentrations in patients with infertility and endometriosis. Forty patients with infertility and laparoscopically proven endometriosis were recruited into the study. Basal serum prolactin levels and prolactin levels after TRH administration were measured. The mean basal serum prolactin concentrations were 12.5, 16.5, 19.5, and 26.5 ng/ml and those after thyrotropin-releasing hormone (TRH) administration were 88.3, 114.2, 125.3 and 138.8 ng/ml in patients with stages I, II, III and IV endometriosis, respectively. A statistically significant relationship was found between the basal serum prolactin levels as well as those after TRH injection and the stage of the endometriosis. The patients were divided in two groups. Group I consisted of 20 patients who did not receive any treatment, while group II consisted of 20 patients who were initially treated with GnRH analogues for 24 week and subsequently with several therapeutic schemes in order to improve their fecundity. The pregnancy rate was not different between the two groups. The patients, however, who did not become pregnant had higher serum prolactin concentrations after TRH administration as compared to those who conceived. We conclude that occult hyperprolactinemia may be a cause of infertility in patients with endometriosis.

Serum prolactin concentration in patients taking neuroleptic drugs.

Non-tumour causes of hyperprolactinaemia, including prolactin-elevating drugs, must be excluded. There is a general view that such drugs are unlikely to raise serum PRL above 3000 mU/I, but the literature is confusing. We report 8 patients receiving treatment with neuroleptic drugs, whose serum PRL concentrations were grossly elevated. Prolactin was measured using a 2-site immunofluorometric assay (Abbott Laboratories; reference range < 500 mU/l). Seven of the eight women (age range 24-49 years) were symptomatic (galactorrhoea, oligo- or amenorrhoea). Prolactin concentrations ranged from 3600 mU/l to 7300 mU/l. All patients had a normal pituitary CT scan. Five patients were treated with bromocriptine without detriment to their mental state. Prolactin can rise to concentrations associated with prolactinomas in patients on neuroleptic drugs. As it is rarely possible to stop the drugs to see if the PRL concentration will decline to normal, neuroradiology is required in these patients to exclude a vision-threatening macroprolactinoma before deciding on medical treatment.

On the nature of serum prolactin in two patients with macroprolactinemia

To further characterize the high molecular weight (MW) forms of prolactin (PRL) present in patients with macroprolactinemia. Case reports with laboratory investigations. Academic medical centers. Two patients with macroprolactinemia. Measurements of PRL concentrations before and after chromatographic separations. The majority of serum PRL had an estimated MW of at least 669 kd in the first patient and approximately 171 kd in the second. During a pregnancy, a new form of PRL (MW 291 kd) appeared in the first patient's serum and persisted for at least 3 years. Immunoprecipitation and polyacrylamide gel electrophoresis under reducing and denaturing conditions revealed that the largest form of PRL (MW 669 kd) was composed mostly of 25 kd glycosylated PRL; intermediate forms (171 kd and 291 kd) were composed of roughly equal portions of 25 kd glycosylated PRL and 23 kd nonglycosylated PRL, whereas "little" PRL in these patients was composed primarily of 23 kd nonglycosylated PRL. Injection of the first patient's serum into rats demonstrated that the human PRL (hPRL) immunoreactivity was cleared from the serum more slowly than the PRL from sera containing predominantly little hPRL; after stimulation with thyrotropin-releasing hormone in the second patient, serum PRL concentrations decayed more slowly than observed in normal subjects. Large forms of serum PRL are at least partially glycosylated. These large forms are heterogeneous, both within and among patients. Delayed clearance may account for increased serum PRL concentrations in patients with macroprolactinemia.

Serum Prolactin as a Correlate of Clinical Response to

The rise in serum prolactin concentration in patients treated with neuroleptic drugs is well documented, but attempts to relate this rise to clinical response have yielded conflicting results. These conflicting results could be explained by design flaws in those studies attempting to relate prolactin to clinical response. Seventy-three newly (re)admitted drug-free schizophrenic men were randomly assigned to receive haloperidol either 5, 10, or 20 mg daily for 4 weeks. Prolactin levels post-treatment were significantly (p less than 0.02) related to global outcome by logistic regression. A serum prolactin level may be a useful guide to the lowest effective dose of haloperidol in newly treated schizophrenic men. Above a plasma prolactin level of approximately 30 ng/ml there was very little increase in response. Patients on the 5, 10, and 20 mg daily haloperidol doses had mean prolactin levels of 16, 32, and 34 ng/ml, respectively.

Serum prolactin concentrations in patients with the acquired immunodeficiency syndrome

Experimental evidence suggests that prolactin is an important immunomodulator hormone. Because this endocrine-immune link may represent a potential new therapeutic avenue, we considered its application in states of immunodeficiency. We hypothesized that serum prolactin concentrations might be abnormal in AIDS. To test this hypothesis, we measured serum prolactin concentrations in blood samples obtained from patients who had either AIDS (n = 15) or AIDS-related complex (n = 12), asymptomatic subjects who were antibody-positive for human immunodeficiency virus (HIV) (n = 10), HIV antibody-negative homosexual subjects (n = 10), and heterosexual HIV antibody-negative controls (n = 21). We found no difference in the serum prolactin concentrations between the five subject groups. We conclude that circulating prolactin values are not altered by HIV infection; however, the possibility that prolactin administration may modulate immune function remains to be tested.

Stability of serum neuroleptic and prolactin concentrations during short- and long-term treatment of schizophrenic patients.

The potential importance of neuroleptic activity measures in the management of schizophrenia warrants attention to the methods for assessing neuroleptic bioactivity and stability of neuroleptic bioactivity over time. We have carried out measurements of serum neuroleptic and prolactin concentrations in 18 schizophrenic patients treated with haloperidol or thioridazine for up to 1 year. Serum neuroleptic levels were measured by a radioreceptor assay using porcine striatum. The lower limit of sensitivity of the assay was 0.6 ng haloperidol/ml, the intra- and interassay coefficients of variation 3 and 9%, respectively. A linear correlation was observed between haloperidol dose (5-30 mg/d) and serum neuroleptic activity (r = 0.706, P less than 0.001) and a curvilinear relationship between thioridazine dose (50-600 mg/d) and serum neuroleptic activity in schizophrenic outpatients. There was a positive correlation between serum neuroleptic and prolactin concentrations for the patients taking haloperidol (r = 0.620, P less than 0.001) or thioridazine (r = 0.542, P less than 0.001). In patients taking a constant dose of haloperidol or thioridazine for up to 1 year serum neuroleptic activity remained stable, suggesting the absence of metabolic tolerance; the observation of a decrease of 38 +/- 16% (mean +/- SD) in serum prolactin concentrations in patients treated with haloperidol but no prolactin decrease with thioridazine suggests that under certain neuroleptic treatment conditions a functional tolerance develops in the tuberoinfundibular dopamine system.

Effect of oral contraceptives on serum prolactin: a longitudinal study in 126 normal premenopausal women.

A prospective longitudinal study was carried out in 126 normal premenopausal women aged 18-34 years to determine the effect of oral contraceptives containing less than 50 micrograms of oestrogen on serum prolactin concentration. The mean prolactin concentration in patients receiving oral contraceptives (n = 80) rose from a control level of 8.9 ng/ml to 10.2 ng/ml at 3 months (P less than 0.05) and 10.9 ng/ml at 12 months (P less than 0.001). In a parallel group of patients (n = 46) who used intrauterine devices for contraception, no significant change in serum prolactin concentration was observed over the same period. It is concluded that currently available oral contraceptives have a small but significant stimulatory effect on prolactin secretion in normal women.

Is amniotic fluid prolactin an osmoregulatory hormone of clinical importance?

The present paper reports on the amniotic fluid prolactin concentrations in 61 pregnancies with undisturbed amniotic fluid volume from the 17th to the 41st week of pregnancy. The amniotic fluid prolactin concentrations reach a peak in the 19th week of pregnancy with a slight decrease to the 21st week. After a plateau from the 23rd to the 31st week of pregnancy, prolactin concentrations decrease to very low levels in late gestation. In pregnancies with disturbed amniotic fluid volume the prolactin concentrations are pathologically changed in comparison with "normal" pregnancies. The authors conclude that the amniotic fluid prolactin concentrations have a characteristic profile depending on the stage of pregnancy. From the pathologic prolactin concentrations in patients with hydramnios and otherwise pathologic pregnancies it may be concluded that prolactin is a clinically relevant osmoregulatory hormone for humans too.

Plasma prolactin and cortisol concentrations in epileptic patients during the night.

Plasma cortisol and prolactin concentrations were determined every four hours, from 8 PM to 8 AM, in 19 epileptic patients during EEG recording of sleep. Data were compared with those obtained from 12 healthy young male volunteers studied under similar conditions. Patients had normal cortisol rhythm, with peak levels at 4 AM or 8 AM and trough at midnight. A sleep-related increase in prolactin concentration was observed in all patients. The range of prolactin concentrations in the patients was also normal. Treatment with valproic acid (ten patients) and frequent abnormal EEG discharges (five patients) did not affect cortisol and prolactin secretion.

Is testicular endocrine function abnormal in young men with spinal cord injuries?

Plasma concentrations of FSH, LH, testosterone and prolactin have been studied in seventeen men, aged 19 to 38 years, with traumatic paraplegia. Plasma testosterone, FSH and LH values were normal in all patients. The median LH concentration in patients was significantly higher (P less than 0.05) than in controls but there was no difference for FSH or testosterone. Plasma prolactin was high in five patients and the median prolactin concentration in patients was significantly greater (P less than 0.001) than in controls. It is concluded that there is no evidence of primary testicular failure in young paraplegics but it is possible that testicular hypofunction in some paraplegics may be related to increased prolactin production.

The value of plasma prolactin levels in the prediction of the responsiveness of growth hormone secretion to bromocriptine and TRH in acromegaly.

The mechanism of the inhibition of growth hormone secretion in response to bromocriptine and the ability of thyrotropin releasing hormone to stimulate growth secretion in acromegaly is unknown. In the present study the relationship between the plasma prolactin concentration of untreated acromegalic patients and the reaction of growth hormone to thyrotropin releasing hormone and bromocriptine was investigated. Plasma prolactin levels were elevated in thirty-three (42%) of seventy-nine untreated acromegalic patients. Seventeen patients had mildly elevated prolactin levels, but in sixteen the plasma prolactin concentration was higher than 30 ng/ml. Bromocriptine (2.5 mg) inhibited growth hormone secretion by more than 50% in 22% of the normoprolactinaemic, in 53% of the mild hyperprolactinaemic and in 88% of the patients with a prolactin level above 30 ng/ml (P less than 0.01 v. normoprolactinaemic; P less than 0.01 v. mildly elevated prolactin levels). An increase of growth hormone secretion by more than 100% of the basal value in response to thyrotropin releasing hormone was observed in 44% of the normoprolactinaemic, in 59% of the mildly hyperprolactinaemic and in 75% of the clearly hyperprolactinaemic patients; (P less than 0.01 v. normo- and mildly hyperprolactinaemic patients). An increased plasma prolactin concentration in patients with acromegaly is accompanied in most patients by a higher sensitivity of growth hormone secretion to bromocriptine.

Stable prolactin level after enhanced estradiol production following dehydroepiandrosterone sulfate

To evaluate whether intravenous injection of dehydroepiandrosterone sulfate (DHEAS), by enhancing estradiol (E2) production, would stimulate prolactin (PRL) secretion in late pregnancy, maternal serum PRL was determined before and 1 to 5 hours after administration of 100 mg of DHEAS in a total of 41 women with normal or complicated late pregnancies (twin pregnancy, pre-eclampsia, intrahepatic cholestasis of pregnancy, diaetes). The basal serum PRL concentration in patients with diabetes was significantly lower than normal. The mean PRL level did not change significantly in any group in spite of the increase in serum E2 levels after the DHEAS injection. The lack of PRL response to a rapid rise in E2 may be due to the maximal inhibition of the PRL-inhibiting factor in the hypothalamus and/or maximal activation of the pituitary lactotrophs occasioned by the high estrogen environment during late pregnancy.