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Sun S, Jin W, Hou T, Tong S, Zhou S, Hong L, Yao K, Zhao K, Zheng T. Psychotic symptoms in Chinese adolescent patients with major depressive disorder: prevalence and related endocrine clinical factors. BMC Psychiatry 2024; 24:598. [PMID: 39237962 PMCID: PMC11376036 DOI: 10.1186/s12888-024-06023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/16/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) is often accompanied by psychotic symptoms. However, few studies have examined the relationship between psychotic symptoms and endocrine factors in adolescent patients with MDD. Therefore, this study aimed to investigate the prevalence and related endocrine clinical factors of psychotic symptoms in Chinese adolescent patients with MDD. METHODS In total, 601 patients (aged 12-18) with MDD were recruited. The Patient Health Questionnaire - 9 items (PHQ - 9) was utilized for assessing depressive symptoms. Psychotic symptoms were assessed through clinical interviews. Prolactin (PRL), thyroid-stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (FT3), thyroxine (T4), and free thyroxine (FT4) were also measured. RESULTS The incidence of psychotic symptoms in adolescent patients with MDD was 22.6%. The findings demonstrated that age, self-harming behavior, PHQ-9 score, FT4, and normalized PRL were independently associated with psychotic symptoms in patients with MDD (All p < 0.05). CONCLUSIONS PRL and FT4 levels are more likely to be abnormally elevated in major depressive adolescents with psychotic symptoms. Prolactin and thyroid hormones in patients with MDD should be paid more attention.
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Affiliation(s)
- Shiyu Sun
- Department of Mental Health, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wei Jin
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Tianle Hou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Siyu Tong
- Lishui Second People's Hospital, Wenzhou Medical University, Lishui, China
| | | | - Lan Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- The Third Hospital of Quzhou, Quzhou, China
| | - Keqing Yao
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China.
- Shenzhen Kangning Hospital, 77 Zhenbi Road, Pingshan District, Shenzhen, Guangdong, China.
| | - Ke Zhao
- Lishui Second People's Hospital, Wenzhou Medical University, Lishui, China.
| | - Tiansheng Zheng
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China.
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Yogeeta F, Rauf SA, Devi M, Imran K, Ahmed R, Aruwani PK, Saad M, Tooba F, Hashmani FZ, Ibrahim M, Kumar N, Shah HH, Hussain T, Haque MA. Prolactinoma: Navigating the Dual Challenge of Side Effects and Treatment Strategies - A Comprehensive Review. Ann Med Surg (Lond) 2024; 86:4613-4623. [PMID: 39118737 PMCID: PMC11305738 DOI: 10.1097/ms9.0000000000002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/11/2024] [Indexed: 08/10/2024] Open
Abstract
This narrative review provides a succinct exploration of prolactinoma, the most common pituitary adenoma, focusing on its epidemiology, clinical manifestations, and therapeutic interventions. Beginning with an overview of its prevalence and aetiology, the review delves into the gender distribution and familial associations of prolactinoma. Clinical presentations, including endocrine disruptions, reproductive health issues, and metabolic disturbances, are examined, emphasizing their impact on hormonal regulation and cardiovascular health. The narrative then navigates through pharmacological treatments, surgical interventions, and radiation therapy, highlighting their efficacy, side effects, and long-term management challenges. Strategies to mitigate side effects and optimize treatment outcomes are discussed, emphasizing the importance of multidisciplinary collaboration in prolactinoma management. This review is a concise yet comprehensive resource for healthcare professionals and researchers, providing insights into prolactinoma's clinical complexities and therapeutic nuances to guide optimal patient care strategies.
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Affiliation(s)
- Fnu Yogeeta
- Department of Internal Medicine, Liaquat National Medical College
| | | | - Muskan Devi
- Department of Internal Medicine, Liaquat National Medical College
| | - Komal Imran
- Department of Internal Medicine, Liaquat National Medical College
| | - Rubayyi Ahmed
- Department of Internal Medicine, Liaquat National Medical College
| | | | - Muhammad Saad
- Department of Internal Medicine, Liaquat National Medical College
| | - Fnu Tooba
- Department of Internal Medicine, Liaquat National Medical College
| | | | - Mufliha Ibrahim
- Department of Internal Medicine, Liaquat National Medical College
| | - Neeraj Kumar
- Department of Internal Medicine, Liaquat National Medical College
| | - Hussain Haider Shah
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tooba Hussain
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Md Ariful Haque
- Department of Public Health, Atish Dipankar University of Science and Technology
- Voice of Doctors Research School, Dhaka, Bangladesh
- Department of Orthopaedic Surgery, Yan’an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China
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Balen AH, Tamblyn J, Skorupskaite K, Munro MG. A comprehensive review of the new FIGO classification of ovulatory disorders. Hum Reprod Update 2024; 30:355-382. [PMID: 38412452 DOI: 10.1093/humupd/dmae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) system for the classification of disorders of ovulation was produced 50 years ago and, by international consensus, has been updated by the International Federation of Gynecology and Obstetrics (FIGO). OBJECTIVE AND RATIONALE This review outlines in detail each component of the FIGO HyPO-P (hypothalamic, pituitary, ovarian, PCOS) classification with a concise description of each cause, and thereby provides a systematic method for diagnosis and management. SEARCH METHODS We searched the published articles in the PubMed database in the English-language literature until October 2022, containing the keywords ovulatory disorders; ovulatory dysfunction; anovulation, and each subheading in the FIGO HyPO-P classification. We did not include abstracts or conference proceedings because the data are usually difficult to assess. OUTCOMES We present the most comprehensive review of all disorders of ovulation, published systematically according to the logical FIGO classification. WIDER IMPLICATIONS Improving the diagnosis of an individual's ovulatory dysfunction will significantly impact clinical practice by enabling healthcare practitioners to make a precise diagnosis and plan appropriate management.
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Affiliation(s)
- Adam H Balen
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | - Jennifer Tamblyn
- Leeds Centre for Reproductive Medicine, The University of Leeds, Leeds, UK
| | | | - Malcolm G Munro
- Department of Obstetrics and Gynecology, The University of California, Los Angeles, Los Angeles, CA, USA
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Cabergoline Failure and a Spontaneous Pregnancy in a Microprolactinoma with High Prolactin Levels. J Pers Med 2022; 12:jpm12122061. [PMID: 36556282 PMCID: PMC9780970 DOI: 10.3390/jpm12122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
We report a particular case of a spontaneously occurring pregnancy in a long-term amenorrheic patient due to a prolactinoma with high serum prolactin (PRL) following the failure of dopamine agonist therapy (DA) for infertility. Initially, clinical, laboratory, and genital ultrasounds were normal, but the serum PRL was 10,074 μIU/mL (n.v.: 127−637 μIU/mL), the PEG fraction was 71% (laboratory cut-off > 60%), and luteinizing hormone (LH) was significantly lower. An MRI revealed a pituitary tumor of 12.8/10 mm with a subacute intratumoral hemorrhage. DA was initiated, and menstrual bleeding reappeared with a reduction in the tumor’s volume to 1.9/2.2 mm at 12 months. Two years later, the patient renounced DA and follow-ups. After another 2 years, she became spontaneously pregnant. Serum PRL was 18,325 μIU/mL, and an MRI revealed a microprolactinoma of 2.1/2 mm. The patient gave birth to a normal baby at term, and she breastfed for six months, after which she asked for ablactation, and DA was administered. This case highlights the possibility of the occurrence of a normal pregnancy during a long period of amenorrhea induced by a microprolactinoma with a high level of serum PRL, even if DA fails to correct infertility. There was no compulsory relationship between the tumoral volume’s evolution and the evolution of its lactophore activity. The hypogonadotrophic hypogonadism induced by high PRL was mainly manifested by low LH, and in this situation, normal levels of FSH and estradiol do not always induce follicle recruitment and development without abnormalities in the ovary ultrasound.
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García Cano AM, Jiménez Mendiguchía L, Rosillo Coronado M, Gómez Lozano A, Del Rey-Mejías ÁL, Fresco Merino M, Marchán Pinedo M, Araujo-Castro M. Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management. ENDOCRINOL DIAB NUTR 2022; 69:771-778. [PMID: 36526352 DOI: 10.1016/j.endien.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND PURPOSE To analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. PATIENTS AND METHODS A 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. RESULTS In 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. CONCLUSION Hyperprolactinaemia 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.
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Affiliation(s)
- Ana M García Cano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal Madrid, Spain.
| | | | | | - Ana Gómez Lozano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal Madrid, Spain
| | | | - María Fresco Merino
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal Madrid, Spain
| | - Marta Marchán Pinedo
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal Madrid, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal Madrid, Spain; Department of Health Science, Universidad Alcalá, Madrid, Spain; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
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Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ren B, Zhu Y. A New Perspective on Thyroid Hormones: Crosstalk with Reproductive Hormones in Females. Int J Mol Sci 2022; 23:ijms23052708. [PMID: 35269847 PMCID: PMC8911152 DOI: 10.3390/ijms23052708] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 12/19/2022] Open
Abstract
Accumulating evidence has shown that thyroid hormones (THs) are vital for female reproductive system homeostasis. THs regulate the reproductive functions through thyroid hormone receptors (THRs)-mediated genomic- and integrin-receptor-associated nongenomic mechanisms, depending on TH ligand status and DNA level, as well as transcription and extra-nuclear signaling transduction activities. These processes involve the binding of THs to intracellular THRs and steroid hormone receptors or membrane receptors and the recruitment of hormone-response elements. In addition, THs and other reproductive hormones can activate common signaling pathways due to their structural similarity and shared DNA consensus sequences among thyroid, peptide, and protein hormones and their receptors, thus constituting a complex and reciprocal interaction network. Moreover, THs not only indirectly affect the synthesis, secretion, and action of reproductive hormones, but are also regulated by these hormones at the same time. This crosstalk may be one of the pivotal factors regulating female reproductive behavior and hormone-related diseases, including tumors. Elucidating the interaction mechanism among the aforementioned hormones will contribute to apprehending the etiology of female reproductive diseases, shedding new light on the treatment of gynecological disorders.
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Affiliation(s)
- Bingtao Ren
- School of Pharmacy, Fudan University, Shanghai 200032, China;
| | - Yan Zhu
- Laboratory of Reproductive Pharmacology, NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Fudan University, Shanghai 200032, China
- Correspondence: ; Tel.: +86-21-64438416
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Is there any association between migraine headache and polycystic ovary syndrome (PCOS)? A review article. Mol Biol Rep 2021; 49:595-603. [PMID: 34651295 DOI: 10.1007/s11033-021-06799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) and migraine headaches are considered to be common health problems that may share some risk factors. This study aimed to discuss the possible association between migraine headache and polycystic ovary syndrome. METHODS AND RESULTS In this narrative review, PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for retrieving and summarizing published studies up to January 2021 to explore the possible interplay between migraine headache and PCOS. We discuss the possible pathways that may explain the association between migraine headaches and PCOS signs/symptoms and complications. While genetic factors have profound effects on the pathogenesis of migraine headaches, sex hormones, including estrogen and progesterone may also play an important role in inducing migraine headaches. Some disorders, such as sleep apnea, amenorrhea, and vascular disease that are more likely to occur in women with PCOS, may cause or exacerbate migraine headaches in women with PCOS. CONCLUSIONS Future comprehensive studies are needed to investigate the exact underlining mechanisms related to the association between PCOS and migraine headaches.
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Menstrual problems are associated with elevated central venous pressure and predict adverse clinical events in women with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Yang H, Lin J, Li H, Liu Z, Chen X, Chen Q. Prolactin Is Associated With Insulin Resistance and Beta-Cell Dysfunction in Infertile Women With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2021; 12:571229. [PMID: 33716958 PMCID: PMC7947819 DOI: 10.3389/fendo.2021.571229] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Our study aimed to investigate if serum prolactin (PRL) levels associated with insulin resistance and beta-cell dysfunction in infertile patients with polycystic ovary syndrome (PCOS). METHODS This was a retrospective cross-sectional study performed in the reproductive medicine center of the first affiliated hospital of Wenzhou Medical University. From January 2007 to August 2018, a total of 792 PCOS and 700 non-PCOS infertile women were included. All patients' prolactin levels were in the normal range. PCOS was diagnosed according to the Rotterdam Criteria. Anthropometric parameters, blood pressure, serum prolactin levels, sex hormones, fasting lipids, fasting plasma glucose (FPG), fasting insulin (FINS) and hepatic biological parameters were measured in all subjects. RESULTS Serum prolactin levels in PCOS women were significantly decreased compared with levels in non-PCOS women after adjusting for age and BMI (P < 0.05). Moreover, we found that prolactin levels were positively associated with high-density lipoprotein cholesterol (HDL-C) and negatively associated with age, BMI, waist circumference (WC), hip circumference (HC), luteinizing hormone/follicle stimulating hormone (LH/FSH), estradiol (E2), FINS, homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β (HOMA-β), triglyceride (TG) and alanine aminotransferase (ALT) (P < 0.05). After adjusting for age and BMI, multiple linear regression analysis revealed that LH, LH/FSH, E2, FINS, HOMA-IR, and HOMA-β were negatively associated with serum PRL (P < 0.05). CONCLUSIONS Low serum PRL levels within the normal range associates with a higher incidence of insulin resistance and beta-cell dysfunction in infertile women with PCOS.
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Affiliation(s)
- Haiyan Yang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Lin
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - He Li
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Zhangwei Liu
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qianqian Chen, ; Xia Chen,
| | - Qianqian Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qianqian Chen, ; Xia Chen,
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Reduced plasma Fetuin-A is a promising biomarker of depression in the elderly. Eur Arch Psychiatry Clin Neurosci 2020; 270:901-910. [PMID: 31863164 DOI: 10.1007/s00406-019-01090-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 12/11/2019] [Indexed: 12/20/2022]
Abstract
Depression affects 7% of the elderly population, and it often remains misdiagnosed or untreated. Peripheral biomarkers might aid clinicians by allowing more accurate and well-timed recognition of the disease. We sought to determine if plasma protein levels predict the severity of depressive symptomatology or distinguish patients from healthy individuals. The severity of depressive symptoms and global cognitive functioning were assessed by the Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE) in 152 elderly subjects, 76 of which with major depressive disorder (MDD). Plasma levels of 24 proteins were measured by multiplexing and analyzed as continuous predictors or dichotomized using the median value. The association between individual plasma proteins and MDD risk or depressive symptoms severity was investigated using multiple logistic and linear regressions including relevant covariates. Sensitivity analyses were performed excluding cognitively impaired individuals or non-acute patients with MDD. After adjusting for possible confounders and false discovery rate (FDR) correction, we found lower Fetuin-A levels in MDD patients vs. controls (pFDR = 1.95 × 10-6). This result was confirmed by the sensitivity and dichotomized analyses. Lower prolactin (PRL) levels predicted more severe depressive symptoms in acute MDD patients (pFDR = 0.024). Fetuin-A is a promising biomarker of MDD in the elderly as this protein was negatively associated with the disorder in our sample, regardless of the global cognitive functioning. Lower PRL levels may be a peripheral signature of impaired neuroprotective processes and serotoninergic neurotransmission in more severely depressed patients.
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The Role of Hormones in Male Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through “stalk effect”) are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.
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Krysiak R, Szkróbka W, Okopień B. The effect of bromocriptine treatment on sexual functioning and depressive symptoms in women with mild hyperprolactinemia. Pharmacol Rep 2018; 70:227-232. [PMID: 29475005 DOI: 10.1016/j.pharep.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elevated prolactin levels are associated with sexual dysfunction in women. No previous study has investigated the effect of dopamine agonists on sexual functioning in women. METHODS The study enrolled 30 young women with mild hyperprolactinemia (serum prolactin levels in the range between 25 and 50ng/mL), 15 of whom were later treated with bromocriptine (5-10mg daily), as well as 14 age- and weight-matched healthy women. All women completed a questionnaire evaluating female sexual function (Female Sexual Function Index - FSFI) and a questionnaire evaluating the presence and severity of depressive symptoms (Beck Depression Inventory Second Edition - BDI-II). RESULTS Women with mild hyperprolactinemia had a lower total FSFI score, lower scores in all domains of sexual functioning (desire, arousal, lubrication, and dyspareunia), as well as a lower total BDI-II score than control women. Bromocriptine increased the FSFI score and tended to reduce BDI-II score. Moreover, the drug normalized desire, arousal, lubrication and dyspareunia, as well as improved orgasm and sexual satisfaction and this action correlated with changes in prolactin levels and an improvement in insulin sensitivity. No changes in sexual functioning and depressive symptoms were observed in untreated women with mild hyperprolactinemia and healthy controls. CONCLUSIONS Bromocriptine treatment improves female sexual functioning and slightly affects depressive symptoms in women with elevated prolactin levels and this effect is related to its prolactin-lowering and metabolic effects.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
| | - Witold Szkróbka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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Subclinical hypothyroidism would not lead to female sexual dysfunction in Chinese women. BMC WOMENS HEALTH 2018; 18:26. [PMID: 29370851 PMCID: PMC5785892 DOI: 10.1186/s12905-017-0465-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/03/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is dearth of research about female sexual dysfunction (FSD), especially in China, because of conservative beliefs. Previous studies indicated the relationship between subclinical hypothyroidism and anxiety and depression. However, there is dearth of research regarding the relationship between subclinical hypothyroidism and FSD in Chinses women. METHOD A hospital-based research was conducted. Female sexual function was measured by CVFSFI which includes 19 items. Participants were identified as FSD if CVFSFI ≤ 23.45. Logistics analysis was used to determine risk factor of FSD. All of them finished CVFSFI, Beck Depression Inventory (BDI) self-reporting questionnaires and had thyroid hormone tests. Based on presence and absence of subclinical hypothyroidism, participants were divided into two groups. Risk factors of FSD were identified. RESULT One thousand one hundred nineteen participants with CVFSFI score 25.8 ± 3.9 were enrolled in final analysis. Incidence of subclinical hypothyroidism and FSD in Chinese women was 15.0% and 26.5% respectively. There were no significant difference between subclinical hypothyroidism and control group in FSFI score and prevalence of FSD. Age, Depression (medium risk) was identified as risk factors for nearly all types of FSD, and Income (ranges from 40,000 to 100,000 RMB/year) as protective factor. Subclinical hypothyroidism had no significant relationship with FSD. CONCLUSION Subclinical hypothyroidism is not the risk factor for FSD in urban women of China.
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Luo H, Yang H, Zhao W, Han Q, Zeng L, Tang H, Zhu J. Elevated free triiodothyronine may lead to female sexual dysfunction in Chinese urban women: A hospital-based survey. Sci Rep 2017; 7:1216. [PMID: 28450708 PMCID: PMC5430714 DOI: 10.1038/s41598-017-01352-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 03/27/2017] [Indexed: 02/05/2023] Open
Abstract
Research on female sexual dysfunction (FSD) is limited, especially in China, due to conservative culture and beliefs. There has been a dearth of FSD screening research in China since the optimal cutoff value of the Chinese version of the Female Sexual Function Index (CVFSFI) was determined in 2014. At the same time, the relationship between thyroid hormones and FSD has seldom been explored in Chinese women. Therefore, hospital-based research was conducted to elucidate FSD frequency and risk factors. Women who underwent a check-up at the Health Promotion Center were approached to participate and, if consented, were enrolled in the study. Demographic and socioeconomic data was extracted. All participants completed the CVFSFI and Beck Depression Inventory (BDI) self-report questionnaires and underwent thyroid hormone tests. A total of 1119 participants were included in the final analysis, with a mean age of 38.6 ± 7.6 years and average CVFSFI score of 25.7 ± 3.9. The frequency of FSD among the participants in this hospital-based cross-sectional study was 26.5%. In addition to age, menopause, parity and depression status as risk factor, and annual income (40,000–100,000 RMB/year) and educational background (≥university) as protective factor, elevated free triiodothyronine (fT3) was identified as an independent risk factor of FSD.
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Affiliation(s)
- Han Luo
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hongliu Yang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, P.R. China.,Biostatistics Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Wanjun Zhao
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Qianqian Han
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, P.R. China.,Biostatistics Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Li Zeng
- Health Promotion Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Huairong Tang
- Health Promotion Center, West China Hospital, Sichuan University, Chengdu, P.R. China.
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
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17
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Riecher-Rössler A. Oestrogens, prolactin, hypothalamic-pituitary-gonadal axis, and schizophrenic psychoses. Lancet Psychiatry 2017; 4:63-72. [PMID: 27856396 DOI: 10.1016/s2215-0366(16)30379-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/07/2016] [Accepted: 07/25/2016] [Indexed: 02/07/2023]
Abstract
Interest is growing in the potential effect of gonadal hormones, prolactin, and the hypothalamic-pituitary-gonadal axis in schizophrenic psychoses. Many studies from clinical, epidemiological, and fundamental research have confirmed that oestradiol, the main component of oestrogens, can have protective effects in schizophrenic psychoses. Furthermore, many patients with schizophrenic psychoses-even in the untreated prodromal stages-have hyperprolactinaemia and gonadal dysfunction, with oestrogen deficiency in women and testosterone deficiency in men. The understanding of the pathogenetic mechanisms underlying these findings could contribute to a better understanding of the aetiopathogenesis of schizophrenic psychoses and improve therapeutic approaches. In this Series paper, we aim to review methodologically sound studies in this area, propose a theory to explain these findings in the context of psychosis, and suggest therapeutic strategies and implications for further research.
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Affiliation(s)
- Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland.
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18
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Krysiak R, Drosdzol-Cop A, Skrzypulec-Plinta V, Okopien B. Sexual function and depressive symptoms in young women with elevated macroprolactin content: a pilot study. Endocrine 2016; 53:291-8. [PMID: 26902871 PMCID: PMC4901097 DOI: 10.1007/s12020-016-0898-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/10/2016] [Indexed: 01/13/2023]
Abstract
Elevated prolactin levels seem to be associated with impaired sexuality. The clinical significance of macroprolactinemia, associated with the predominance of high molecular mass circulating forms of prolactin, is still poorly understood. This study was aimed at investigating sexual function in young women with macroprolactinemia. The study enrolled 14 young women with macroprolactinemia, 14 with increased monomeric prolactin levels, as well as 14 age- and weight-matched healthy women. All patients completed a questionnaire evaluating female sexual function (Female Sexual Function Index-FSFI), as well as a questionnaire assessing the presence and severity of depressive symptoms (Beck Depression Inventory Second Edition-BDI-II). Apart from total prolactin levels and macroprolactin content, circulating levels of thyrotropin, total testosterone, and 17-β estradiol were also measured. Patients with elevated monomeric prolactin levels had a lower total FSFI score, as well as lower scores for all domains: sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and dyspareunia. These scores correlated with total and monomeric prolactin levels. In turn, women with macroprolactinemia were characterized by a lower score for sexual desire, and only this score correlated with total prolactin levels and macroprolactin content. The total score in the BDI-II questionnaire was higher in patients with hyper- and macroprolactinemia than in the control subjects. Contrary to multidimensional impairment of sexual function in women with elevated monomeric prolactin, macroprolactinemia only seems to disturb sexual desire.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, ul. Medyków 18, 40-752, Katowice, Poland
| | - Agnieszka Drosdzol-Cop
- Chair of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, ul. Medyków 12, 40-752, Katowice, Poland.
| | - Violetta Skrzypulec-Plinta
- Chair of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, ul. Medyków 12, 40-752, Katowice, Poland
| | - Bogusław Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, ul. Medyków 18, 40-752, Katowice, Poland
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19
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rpsmen.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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20
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Krysiak R, Drosdzol-Cop A, Skrzypulec-Plinta V, Okopien B. Sexual function and depressive symptoms in young women with thyroid autoimmunity and subclinical hypothyroidism. Clin Endocrinol (Oxf) 2016; 84:925-31. [PMID: 26426544 DOI: 10.1111/cen.12956] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/18/2015] [Accepted: 09/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The results of few studies conducted to date suggest an increased prevalence of sexual dysfunction in patients with thyroid disorders. DESIGN The aim of this study was to compare female sexual function and depressive symptoms between women with autoimmune thyroid disease and with mild thyroid failure. PATIENTS The study included four groups of young women: euthyroid women with Hashimoto's thyroiditis (Group 1), women with nonautoimmune subclinical hypothyroidism (Group 2), women with autoimmune subclinical hypothyroidism (Group 3) and healthy euthyroid females without thyroid autoimmunity (Group 4). MEASUREMENTS Beyond measuring serum hormone levels and thyroid antibody titres, all enrolled women completed questionnaires evaluating female sexual function (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition - BDI-II). RESULTS The mean total FSFI score was lower in women with autoimmune hypothyroidism than in the remaining groups of women, as well as lower in Groups 1 and 2 than in Group 4. Compared to Group 4, three domains (sexual desire, lubrication and sexual satisfaction) were lower in Group 1, four domains (desire, arousal, lubrication and dyspareunia) in Group 2 and all FSFI domain scores in Group 3. The total BDI-II score was higher in Groups 1 and 2 than in Group 4, as well as higher in Group 3 than in the other groups of women. CONCLUSIONS The obtained results suggest that both thyroid autoimmunity and mild thyroid failure, particularly if they occur together, may negatively affect female sexual function and depressive symptoms.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | | | | | - Bogusław Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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21
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Update on prolactinomas. Part 1: Clinical manifestations and diagnostic challenges. J Clin Neurosci 2016; 22:1562-7. [PMID: 26256063 DOI: 10.1016/j.jocn.2015.03.058] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 11/20/2022]
Abstract
The authors provide an update on the clinical manifestations and diagnostic challenges of prolactinomas. Prolactinomas are the most common pituitary adenoma seen in clinical practice. Secondary causes of hyperprolactinemia should be ruled out by assessment of the clinical history, including current medications, physical examination, pregnancy test, routine biochemical analysis with a thyroid function test, and neuroimaging, before a confirmatory diagnosis of prolactinoma is made. Prolactinomas are associated with endocrine dysfunction, affecting gonadal function and causing neurological deficits due to mass effect. The progress in elucidating the pathogenesis of prolactinomas and advances in diagnostic methods, including more sensitive diagnostic hormone assays and neuroimaging, have enriched the current diagnostic approach and management. Making the correct diagnosis is crucial to implementing the appropriate therapy. Dopamine agonist therapy remains the first line of treatment for prolactinomas, as it is effective in normalizing serum prolactin levels and reducing tumor size. Surgery is typically indicated for patients who are resistant to medical therapy or intolerant of its adverse side effects, or for those experiencing progressive neurological deficits. Nevertheless, curative surgical resection as a primary mode of treatment for smaller prolactinomas has recently gained attention as an alternative to lifelong dopamine agonist treatment.
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22
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, Del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 9:158-73. [PMID: 26927534 DOI: 10.1016/j.rpsm.2015.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/28/2015] [Accepted: 11/16/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Iatrogenic hyperprolactinaemia (IHPRL) has been more frequently related to some antipsychotic drugs that provoke an intense blockade of dopamine D2 receptors. There is a wide variation in clinical practice, and perhaps some more awareness between clinicians is needed. Due to the high frequency of chronic treatment in severe mental patients, careful attention is recommended on the physical risk. IHPRL symptoms could be underestimated without routine examination. METHODOLOGY An intense scientific literature search was performed in order to draw up a multidisciplinary consensus, including different specialists of psychiatry, endocrinology, oncology and internal medicine, and looking for a consensus about clinical risk and detection of IHPRL following evidence-based medicine criteria levels (EBM I- IV). RESULTS Short-term symptoms include amenorrhea, galactorrhoea, and sexual dysfunction with decrease of libido and erectile difficulties related to hypogonadism. Medium and long-term symptoms related to oestrogens are observed, including a decrease bone mass density, hypogonadism, early menopause, some types of cancer risk increase (breast and endometrial), cardiovascular risk increase, immune system disorders, lipids, and cognitive dysfunction. Prolactin level, gonadal hormones and vitamin D should be checked in all patients receiving antipsychotics at baseline although early symptoms (amenorrhea-galactorrhoea) may not be observed due to the risk of underestimating other delayed symptoms that may appear in the medium term. Routine examination of sexual dysfunction is recommended due to possible poor patient tolerance and low compliance. Special care is required in children and adolescents, as well as patients with PRL levels >50ng/ml (moderate hyperprolactinaemia). A possible prolactinoma should be investigated in patients with PRL levels >150ng/ml, with special attention to patients with breast/endometrial cancer history. Densitometry should be prescribed for males >50 years old, amenorrhea>6 months, or early menopause to avoid fracture risk.
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Affiliation(s)
- Ángel L Montejo
- Área de Neurociencias, Instituto de Biomedicina de Salamanca (IBSAL), Universidad de Salamanca, Servicio de Psiquiatría, Hospital Universitario de Salamanca, España.
| | - Celso Arango
- Departamento de Psiquiatría Infanto-Juvenil, Hospital General Universitario Gregorio Marañón (IiSGM). Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Miguel Bernardo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - José L Carrasco
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, CIBERSAM, Madrid, España
| | - Benedicto Crespo-Facorro
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria. Hospital Universitario Marqués de Valdecilla, IDIVAL, CIBERSAM, Santander, España
| | - Juan J Cruz
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Universidad de Salamanca (IBSAL), España
| | - Javier Del Pino
- Servicio Medicina Interna, Hospital Clínico Universitario, Universidad de Salamanca, España
| | | | - Clemente García Rizo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - Ana González-Pinto
- International Mood Disorders Research Centre, CIBERSAM, Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España
| | - Ana I Hernández
- FEA Psiquiatría, Red de Salud Mental de Guipúzcoa, San Sebastián, España
| | - Manuel Martín Carrasco
- Instituto de Investigaciones Psiquiátricas, Fundación María Josefa Recio, Bilbao, España; Clínica Psiquiátrica Padre Menni, CIBERSAM, Pamplona, España
| | - Fermin Mayoral Cleries
- UGC Salud Mental, Hospital Regional Universitario, Instituto de Biomedicina de Málaga, Málaga, España
| | | | - M Teresa Mories
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Salamanca, España
| | - Isabella Pachiarotti
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
| | - Salvador Ros
- Instituto Internacional de Neurociencias Aplicadas, Barcelona, España
| | - Eduard Vieta
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
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23
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Krysiak R, Kowalska B, Szkróbka W, Okopień B. The effect of oral contraception on macroprolactin levels in women with macroprolactinemia: A pilot study. Pharmacol Rep 2015; 67:854-7. [PMID: 26398376 DOI: 10.1016/j.pharep.2015.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/27/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a high prevalence of macroprolactinemia in the population, the only drugs found to change macroprolactin (big-big prolactin) levels were dopamine receptor agonists. METHODS The aim of this study was to investigate the effect of oral contraceptive pills containing ethinyl estradiol and levonorgestrel on serum macroprolactin levels in patients with macroprolactinemia. The study population included 21 premenopausal women with isolated macroprolactinemia, 11 of whom were treated with oral contraceptive pills. Serum prolactin and macroprolactin levels were assessed at baseline and after 16 weeks of treatment. RESULTS Oral contraceptive pills administered for 16 weeks slightly increased pre-polyethylene glycol serum prolactin levels and macroprolactin levels and the effect of this treatment correlated with their baseline values. CONCLUSIONS Our results suggest that oral contraceptive pills containing ethinyl estradiol and levonorgestrel exhibit a stimulatory effect on macroprolactin production in women with basically high macroprolactin levels.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
| | - Beata Kowalska
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland; Department of Endocrinology, Provincial Hospital, Opole, Poland
| | - Witold Szkróbka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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24
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Wong A, Eloy JA, Couldwell WT, Liu JK. Update on prolactinomas. Part 2: Treatment and management strategies. J Clin Neurosci 2015; 22:1568-74. [PMID: 26243714 DOI: 10.1016/j.jocn.2015.03.059] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
Abstract
The authors present an update on the various treatment modalities and discuss management strategies for prolactinomas. Prolactinomas are the most common type of functional pituitary tumor. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas because of its effectiveness in normalizing serum prolactin levels and shrinking tumor size. Though withdrawal of dopamine agonist treatment is safe and may be implemented following certain recommendations, recurrence of disease after cessation of the drug occurs in a substantial proportion of patients. Concerns regarding the safety of dopamine agonists have been raised, but its safety profile remains high, allowing its use during pregnancy. Surgery is typically indicated for patients who are resistant to medical therapy or intolerant of its adverse side effects, or are experiencing progressive tumor growth. Surgical resection can also be considered as a primary treatment for those with smaller focal tumors where a biochemical cure can be expected as an alternative to lifelong dopamine agonist treatment. Stereotactic radiosurgery also serves as an option for those refractory to medical and surgical therapy.
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Affiliation(s)
- Anni Wong
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology, Head and Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - James K Liu
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology, Head and Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
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25
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Abstract
Prolactin (PRL) is a hormone, mainly secreted by lactotroph cells of the anterior pituitary gland. Recent studies have shown it may also be produced by many extrapituitary cells. Its well-recognized PRL plays an important role in lactation during pregnancy, but it is involved in other biological functions such as angiogenesis, immunoregulation and osmoregulation. Hyperprolactinemia is a typical condition producing reproductive dysfunction in both sexes, resulting in hypogonadism, infertility and galactorrhea. It may be also asymptomatic. Lactotroph adenomas (prolactinoma) is one of the most common cause of PRL excess, representing approximately 40% of all pituitary tumors. Several other conditions should be excluded before a clear diagnosis of hyperprolactinemia is made. Hyperprolactinemia may be secondary to pharmacological or pathological interruption of hypothalamic-pituitary dopaminergic pathways or idiopathic. Stress, renal failure or hypothyroidism are other frequent conditions to exclude in patients with hyperprolactinemia. We will review biochemical characteristics and physiological functions of that hormone. Clinical and pharmacological approach to hyperprolactinemia will also be discussed.
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Affiliation(s)
- Anna Capozzi
- a Department of Endocrinology and Metabolism and
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26
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Goel P, Kahkasha, Narang S, Gupta BK, Goel K. Evaluation of serum prolactin level in patients of subclinical and overt hypothyroidism. J Clin Diagn Res 2015; 9:BC15-7. [PMID: 25737975 PMCID: PMC4347066 DOI: 10.7860/jcdr/2015/9982.5443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prolactin secretion is controlled by prolactin inhibitor factor that is secreted from hypothalamus; factors like vasoactive inhibitory peptide (VIP) and thyroid releasing hormone (TRH) lead to increase in prolactin secretion. Hyperprolactinemia is a common condition that can result from a number of causes including hypothyroidism. Objective of the study was to determine correlation between serum levels of prolactin and thyroid hormones in euthyroid, subclinical and overt hypothyroid cases. MATERIALS AND METHODS Consecutive patients presenting for various thyroid related problems were segregated into two groups subclinical and overt hypothyroidism according to their diagnosis based on history and clinical examination, laboratory reports, inclusion and exclusion criteria. Newly diagnosed 75 patients in each group were finally enrolled. Similar number of age and sex matched controls were selected. All subjects filled a predesigned questionnaire for the evaluation of hypothyroid symptoms. Thyroid profile for T3, T4 (total and free), TSH and prolactin were determined in all the subjects and analyzed. RESULTS Prolactin elevation was found in 16 patients (21.33 %) with overt hypothyroidism, and in six patients (8%) with subclinical hypothyroidism. The control group and subclinical hypothyroid patients exhibited no significant difference in terms of total and free T3, total and free T4. For TSH and prolactin on the other hand, a statistically significant elevation was found in patients with overt hypothyroidism when compared with subclinical hypothyroidism; and in patients with subclinical hypothyroidism when compared to the controls. A significant statistical difference was observed between the two groups of hypothyroid patients for all hypothyroid symptoms except alopecia and hirsuitism. CONCLUSION The incidence of hyperprolactinemia in hypothyroidism was found to be higher when compared with normal controls. Serum prolactin assessment should be performed on all patients with hypothyroidism (overt and subclinical) before performing further tests.
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Affiliation(s)
- Parul Goel
- Assistant Professor, Department of Biochemistry, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Kahkasha
- Assistant Professor, Department of Biochemistry, Hamdard Institute of Medical Science and Research, Hamdard University, New Delhi, India
| | - Shveta Narang
- Senior Resident, Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India
| | - Bharat K Gupta
- Professor, Department of Biochemistry, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, India
| | - Kapil Goel
- EIS Officer, National Center for Disease Control (NCDC), New Delhi, India
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27
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Abstract
We present the case of a patient treated for hyperprolactinaemia with weekly doses of cabergoline for 12 years. Over this time she had suffered from binge eating and compulsive shopping which impacted on her weight and made her finances precarious. We discuss the features of impulse control disorders and suggest that seeking out these side effects in patients taking such agents is important. The behaviours may be embarrassing and patients may not volunteer them, likewise if the doctor dismisses them they may continue unabated, causing significant social harm.
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28
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Sangeeta Devi Y, Halperin J. Reproductive actions of prolactin mediated through short and long receptor isoforms. Mol Cell Endocrinol 2014; 382:400-410. [PMID: 24060636 DOI: 10.1016/j.mce.2013.09.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/20/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
Prolactin (PRL) is a polypeptide hormone with a wide range of physiological functions, and is critical for female reproduction. PRL exerts its action by binding to membrane bound receptor isoforms broadly classified as the long form and the short form receptors. Both receptor isoforms are highly expressed in the ovary as well as in the uterus. Although signaling through the long form is believed to be more predominant, it remains unclear whether activation of this isoform alone is sufficient to support reproductive functions or whether both types of receptor are required. The generation of transgenic mice selectively expressing either the short or the long form of PRL receptor has provided insight into the differential signaling mechanisms and physiological functions of these receptors. This review describes the essential finding that both long and short receptor isoforms are crucial for ovarian functions and female fertility, and highlights novel mechanisms of action for these receptors.
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Affiliation(s)
- Y Sangeeta Devi
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI-49503, USA.
| | - Julia Halperin
- Centro de Estudios Biomédicos, Biotecnológicos, Ambientales y Diagnóstico (CEBBAD), Universidad Maimónides, Hidalgo 775 6to piso, C1405BCK Ciudad Autónoma de Buenos Aires, Argentina and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rivadavia 1917, Ciudad Autónoma de Buenos Aires, Argentina.
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29
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Mon SY, Alkabbani A, Hamrahian A, Thorton JN, Kennedy L, Weil R, Olansky L, Doshi K, Makin V, Hatipoglu B. Risk of thromboembolic events in patients with prolactinomas compared with patients with nonfunctional pituitary adenomas. Pituitary 2013. [PMID: 23203499 DOI: 10.1007/s11102-012-0450-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prolactin has been proposed as a potent coactivator of platelet aggregation, possibly contributing to thromboembolic events. The objective of the study was to evaluate the relationship between prolactinoma and deep vein thrombosis (DVT), pulmonary embolism (PE), and cerebrovascular accident (CVA). Subjects were identified from a prospectively maintained pituitary database at the Cleveland Clinic. We retrospectively reviewed the charts of 544 subjects: 347 patients with prolactinomas (prolactinoma group) and 197 patients with nonfunctional pituitary adenomas (control group). Main outcome measures were DVT, PE and CVA. We found that 19 (5.5%) patients in the prolactinoma group and five (2.5%) patients in the control group had documented DVT, PE, or CVA, but this difference was not significant (p = 0.109). However, the mean initial prolactin level was higher at the time of diagnosis among prolactinoma patients than among controls (815.23 ng/ml vs. 15.90 ng/ml; p < 0.001). Among prolactinoma patients, 15 (5.5%) of 275 patients who underwent medical treatment (with cabergoline, bromocriptine, pergolide and/or other drug) and 4 (5.6%) of 72 patients who underwent transsphenoidal surgery had documented DVT, PE, or CVA, which suggests that dopaminergic therapy did not influence the risk of thromboembolic events. Hyperprolactinemia per se does not appear to predispose to a hypercoagulable state.
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30
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Riecher-Rössler A, Rybakowski JK, Pflueger MO, Beyrau R, Kahn RS, Malik P, Fleischhacker WW. Hyperprolactinemia in antipsychotic-naive patients with first-episode psychosis. Psychol Med 2013; 43:2571-2582. [PMID: 23590895 DOI: 10.1017/s0033291713000226] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hyperprolactinemia is frequent in patients with schizophrenic psychoses. It is usually regarded as an adverse effect of antipsychotics but has recently also been shown in patients without antipsychotic medication. Our objective was to test whether hyperprolactinemia occurs in antipsychotic-naive first-episode patients (FEPs). METHOD In the framework of the European First Episode Schizophrenia Trial (EUFEST), 249 out of 498 FEPs were eligible for this study, of whom 74 were antipsychotic naive. All patients were investigated regarding their serum prolactin levels with immunoassays standardized against the 3rd International Reference Standard 84/500. RESULTS Twenty-nine (39%) of the 74 antipsychotic-naive patients showed hyperprolactinemia not explained by any other reason, 11 (50%) of 22 women and 18 (35%) of 52 men. CONCLUSIONS Hyperprolactinemia may be present in patients with schizophrenic psychoses independent of antipsychotic medication. It might be stress induced. As enhanced prolactin can increase dopamine release through a feedback mechanism, this could contribute to explaining how stress can trigger the outbreak of psychosis.
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Kessenich CR, Bacher K. Elevated prolactin levels in men. Nurse Pract 2013; 38:8-10. [PMID: 24141543 DOI: 10.1097/01.npr.0000434097.64842.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Cathy R Kessenich
- Cathy R. Kessenich is a Professor of Nursing and MSN Program Director at University of Tampa, Tampa, Fla. Kathryn Bacher is an MSN student at University of Tampa, Tampa, Fla
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The Effects of Antipsychotics on Prolactin Levels and Women's Menstruation. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:502697. [PMID: 24490071 PMCID: PMC3886401 DOI: 10.1155/2013/502697] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/11/2013] [Indexed: 01/28/2023]
Abstract
Introduction. Typical and atypical antipsychotic agent is currently used for treatment in the majority of patients with psychotic disorders. The aim of this review is to assess antipsychotic induced hyperprolactinaemia and the following menstrual dysfunction that affects fertility, quality of life, and therapeutic compliance of women. Method. For this purpose, Medline, PsychInfo, Cochrane library, and Scopus databases were accessed, with a focus on the publication dates between 1954 and 2012. Research of references was also performed and 78 studies were retrieved and used for the needs of this review. Results. A summary of several antipsychotics as well as frequency rates and data on hyperprolactinaemia and menstrual disorders for different agent is presented. Conclusion. Diverse prevalence rates of hyperprolactinaemia and menstrual abnormalities have been found about each medication among different studies. Menstruation plays an important role for women, thus, understanding, careful assessment, and management of hyperprolactinaemia could enhance their lives, especially when dealing with women that suffer from a psychotic disorder.
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Management of anovulatory infertility. Best Pract Res Clin Obstet Gynaecol 2012; 26:757-68. [DOI: 10.1016/j.bpobgyn.2012.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/21/2012] [Accepted: 05/20/2012] [Indexed: 11/23/2022]
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Fatfouta I, Delotte J, Mialon O, Isnard V, Bongain A. [Prolactinoma: from quest of pregnancy to delivery]. ACTA ACUST UNITED AC 2012; 42:316-24. [PMID: 23040266 DOI: 10.1016/j.jgyn.2012.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 08/03/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
Prolactinoma is the most frequent hormone-secreting pituitary tumor (100 for million patients) and a major cause of both female and male reproductive function disorders. Physician, gynecologist, urologist and sexologist can face this situation during their career. As part of the fertility restoration, treatment gives very satisfactory results. With adequate management, most women are expected to achieve successful pregnancies. The natural history of these tumors during pregnancy depends on their size with a risk of a clinically relevant estimate between 5 to 30 %. Their management is complex, requiring finding balance between effects of pregnancy on tumor growth and potential risks of overtreatment on fetal development. The aim of this study is to discuss the management of prolactinoma on woman before, during and after pregnancy, and to evaluate the medical and surgical alternatives regarding the actual literature.
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Affiliation(s)
- I Fatfouta
- Service de gynécologie-obstétrique-reproduction et de médecine fœtale, centre hospitalo-universitaire, hôpital de l'Archet-2, BP 3079, route de Saint-Antoine-de-Ginestière, 06202 Nice cedex 3, France.
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Uguz F, Sahingoz M, Kose SA, Ozbebit O, Sengul C, Selvi Y, Sengul CB, Ayhan MG, Dagistanli A, Askin R. Antidepressants and menstruation disorders in women: a cross-sectional study in three centers. Gen Hosp Psychiatry 2012; 34:529-33. [PMID: 22534402 DOI: 10.1016/j.genhosppsych.2012.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The relationship between menstruation disorders and antidepressant drugs usage in women remains unclear. In this study, we aimed to investigate the incidence rate of antidepressant-related menstruation disorders and to examine whether or not antidepressant use is associated with menstrual disorders in women. METHODS The study sample was gathered from three centers and four hospitals. A total of 1432 women who met the criteria of inclusion were included in the study. The sample was divided into two groups: the antidepressant group (n=793) and the control group (n=639). The menstruation disorders were established with reports from the study participants on the basis of related gynecological descriptions. RESULTS The prevalence of menstrual disorders was significantly higher in the antidepressant group (24.6%) than the control group (12.2%). The incidence of antidepressant-induced menstruation disorder was 14.5%. The antidepressants most associated with menstrual disorders were paroxetine, venlafaxine, sertraline and their combination with mirtazapine. Overall, the incidence rate was similar in women receiving selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors. CONCLUSIONS The results of the present study suggest that menstruation disorders are frequently observed in women taking antidepressants and that it appears to be associated with antidepressant use at least in some women.
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Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, Konya University, Konya, Turkey.
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Bussone G, Usai S, Moschiano F. How to Investigate and Treat: Headache and Hyperprolactinemia. Curr Pain Headache Rep 2012; 16:365-70. [DOI: 10.1007/s11916-012-0267-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sahlholm K, Barchad-Avitzur O, Marcellino D, Gómez-Soler M, Fuxe K, Ciruela F, Arhem P. Agonist-specific voltage sensitivity at the dopamine D2S receptor--molecular determinants and relevance to therapeutic ligands. Neuropharmacology 2011; 61:937-49. [PMID: 21752340 DOI: 10.1016/j.neuropharm.2011.06.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 05/20/2011] [Accepted: 06/24/2011] [Indexed: 10/18/2022]
Abstract
Voltage sensitivity has been demonstrated for some GPCRs. At the dopamine D(2S) receptor, this voltage sensitivity is agonist-specific; some agonists, including dopamine, exhibit decreased potency at depolarized potentials, whereas others are not significantly affected. In the present study, we examined some of the receptor-agonist interactions contributing to these differences, and investigated how dopamine D(2S) receptor voltage sensitivity affects clinically used dopamine agonists. GIRK channel activation in voltage-clamped Xenopus oocytes was used as readout of receptor activation. Structurally distinct agonists and complementary site-directed mutagenesis of the receptor's binding site were used to investigate the role of agonist-receptor interactions. We also confirmed that the depolarization-induced decrease of dopamine potency in GIRK activation is correlated by decreased binding of radiolabeled dopamine, and by decreased potency in G protein activation. In the mutagenesis experiments, a conserved serine residue as well as the conserved aspartate in the receptor's binding site were found to be important for voltage sensitive potency of dopamine. Furthermore, the voltage sensitivity of the receptor had distinct effects on different therapeutic D(2) agonists. Depolarization decreased the potency of several compounds, whereas for others, efficacy was reduced. For some agonists, both potency and efficacy were diminished, whereas for others still, neither parameter was significantly altered. The present work identifies some of the ligand-receptor interactions which determine agonist-specific effects of voltage at the dopamine D(2S) receptor. The observed differences between therapeutic agonists might be clinically relevant, and make them potential tools for investigating the roles of dopamine D(2) receptor voltage sensitivity in native tissue.
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Langan EA, Foitzik-Lau K, Goffin V, Ramot Y, Paus R. Prolactin: an emerging force along the cutaneous-endocrine axis. Trends Endocrinol Metab 2010; 21:569-77. [PMID: 20598901 DOI: 10.1016/j.tem.2010.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 05/30/2010] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
Abstract
Prolactin (PRL), one of the most diverse regulators in mammalian biology, is produced in both human skin and hair follicles. Important advances in our understanding of the intracutaneous regulation and functions of PRL have recently been made using the serum-free skin and hair follicle organ culture technique. Given that human skin is the largest peripheral endocrine organ and a key interface between the endocrine, nervous and immune systems, a detailed understanding of PRL in the cutaneous context promises to have far-reaching implications beyond the skin. The current review presents a timely cutaneous perspective on the production, regulation and functions of PRL and summarizes the key questions facing extrapituitary PRL research in general and cutaneous PRL research in particular.
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Affiliation(s)
- Ewan A Langan
- Epithelial Sciences, School of Translational Medicine, University of Manchester, Manchester, UK
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Atis G, Dalkilinc A, Altuntas Y, Atis A, Caskurlu T, Ergenekon E. Sexual Dysfunction in Women with Clinical Hypothyroidism and Subclinical Hypothyroidism. J Sex Med 2010; 7:2583-90. [DOI: 10.1111/j.1743-6109.2010.01815.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kostrzak A, Warenik-Szymankiewicz A, Meczekalski B. The role of serum PRL bioactivity evaluation in hyperprolactinaemic women with different menstrual disorders. Gynecol Endocrinol 2009; 25:799-806. [PMID: 19905999 DOI: 10.3109/09513590903209329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of the study was to characterize the bioactivity of prolactin (PRL) in hyperprolactinaemic patients with prolactinomas, irregular menstrual cycles, regular menstrual cycles and PCOS. METHODS Serum PRL, biological activity of PRL (after polyethylene glycol (PEG) precipitation) and serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), thyroid-stimulating hormone (TSH) concentrations were measured in all hyperprolactinaemic patients and control group (healthy subjects). Correlations between active PRL (PRL-PEG) and serum FSH, LH, E2, T, TSH concentrations were also evaluated. RESULTS Prolactinoma is characterized by high serum PRL levels and its high biological activity. Hyperprolactinaemic patients with irregular cycles were characterized by high biological activity of PRL. Patients with hyperprolactinaemia and regular cycles had low biological activity of PRL. CONCLUSIONS Diagnosis of hyperprolactinaemia should be associated with estimation of PRL biological activity because it is important for type of hyperprolactinaemia management. Low biological activity of PRL does not impair FSH and LH secretion and does not cause hypoestrogenism.
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Affiliation(s)
- A Kostrzak
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
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Bhuvaneswar CG, Baldessarini RJ, Harsh VL, Alpert JE. Adverse endocrine and metabolic effects of psychotropic drugs: selective clinical review. CNS Drugs 2009; 23:1003-21. [PMID: 19958039 DOI: 10.2165/11530020-000000000-00000] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The article critically reviews selected, clinically significant, adverse endocrine and metabolic effects associated with psychotropic drug treatments, including hyperprolactinaemia, hyponatraemia, diabetes insipidus, hypothyroidism, hyperparathyroidism, sexual dysfunction and virilization, weight loss, weight gain and metabolic syndrome (type 2 diabetes mellitus, dyslipidaemia and hypertension). Such effects are prevalent and complex, but can be managed clinically when recognized. They encourage continued critical assessment of benefits versus risks of psychotropic drugs and underscore the importance of close coordination of psychiatric and general medical care to improve long-term health of psychiatric patients. Options for management of hyperprolactinaemia include lowering doses, switching to agents such as aripiprazole, clozapine or quetiapine, managing associated osteoporosis, carefully considering the use of dopamine receptor agonists and ruling out stress, oral contraceptive use and hypothyroidism as contributing factors. Disorders of water homeostasis may include syndrome of inappropriate antidiuretic hormone (SIADH), managed by water restriction or slow replacement by hypertonic saline along with drug discontinuation. Safe management of diabetes insipidus, commonly associated with lithium, involves switching mood stabilizer and consideration of potassium-sparing diuretics. Clinical hypothyroidism may be a more useful marker than absolute cut-offs of hormone values, and may be associated with quetiapine, antidepressant and lithium use, and managed by thyroxine replacement. Hyper-parathyroidism requires comprehensive medical evaluation for occult tumours. Hypocalcaemia, along with multiple other psychiatric and medical causes, may result in decreased bone density and require evaluation and management. Strategies for reducing sexual dysfunction with psychotropics remain largely unsatisfactory. Finally, management strategies for obesity and metabolic syndrome are reviewed in light of the recent expert guidelines, including risk assessment and treatments, such as monoamine transport inhibitors, anticonvulsants and cannabinoid receptor antagonists, as well as lifestyle changes.
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Affiliation(s)
- Chaya G Bhuvaneswar
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Outpatient Clinic of Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
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