Elevated prolactin serum levels and history of alcohol withdrawal seizures

Factors associated with the level of prolactin in patients under remission from Alcohol Use Disorder: A gender perspective

BACKGROUND

Prolactin mirrors the dopaminergic activity in the brain which is key to understanding alcohol use disorders (AUD). Still, patients with AUD are a heterogenous group and there seem to be gender differences in the relationship between alcohol use and the level of prolactin. In this study, we examined gender-wise relationship of alcohol use trait- and state-related factors with the level of prolactin among AUD inpatients in remission.

METHODS

This cross-sectional study examined the level of prolactin along with general patient characteristics and alcohol use trait- and state-related factors that could influence the level of prolactin in 112 AUD inpatients at three rehabilitation clinics in Norway. Logistic regression was performed to identify the gender-specific predictors of level of prolactin.

RESULTS

Male and female AUD patients had similar level of prolactin. Among females, younger age, early alcohol debut, and absence of parental drinking problem predicted higher level of prolactin. In males, presence of other substance dependence predicted a lower level of prolactin.

CONCLUSIONS

There were gender differences in the factors associated with the level of prolactin among the AUD patients. Especially in the female AUD patients under remission, alcohol use trait-related factors were better predictors of the level of prolactin than the alcohol use state-related factors, indicating that individuals might characteristically have varying degree of dopamine reactivity.

The relationship of appetitive, reproductive and posterior pituitary hormones to alcoholism and craving in humans

A significant challenge for understanding alcoholism lies in discovering why some, but not other individuals, become dependent on alcohol. Genetic, environmental, cultural, developmental, and neurobiological influences are recognized as essential factors underlying a person's risk for becoming alcohol dependent (AD); however, the neurobiological processes that trigger this vulnerability are still poorly understood. Hormones are important in the regulation of many functions and several hormones are strongly associated with alcohol use. While medical consequences are important, the primary focus of this review is on the underlying confluence of appetitive/feeding, reproductive and posterior pituitary hormones associated with distinct phases of alcoholism or assessed by alcohol craving in humans. While these hormones are of diverse origin, the involvement with alcoholism by these hormone systems is unmistakable, and demonstrates the complexity of interactions with alcohol and the difficulty of successfully pursuing effective treatments. Whether alcohol associated changes in the activity of certain hormones are the result of alcohol use or are the result of an underlying predisposition for alcoholism, or a combination of both, is currently of great scientific interest. The evidence we present in this review suggests that appetitive hormones may be markers as they appear involved in alcohol dependence and craving, that reproductive hormones provide an example of the consequences of drinking and are affected by alcohol, and that posterior pituitary hormones have potential for being targets for treatment. A better understanding of the nature of these associations may contribute to diagnosing and more comprehensively treating alcoholism. Pharmacotherapies that take advantage of our new understanding of hormones, their receptors, or their potential relationship to craving may shed light on the treatment of this disorder.

Indicators for elevated risk factors for alcohol-withdrawal seizures: an analysis using a random forest algorithm

Alcohol-withdrawal seizures (AWS) are an important and relevant complication during detoxification in alcohol-dependent patients. Therefore, it is important to evaluate the individual risk for AWS. We apply a random forest algorithm to assess possible predictive markers in a large sample of 200 alcohol-dependent patients undergoing alcohol withdrawal. This analysis showed that the combination of homocysteine, prolactin, blood alcohol concentration on admission, number of preceding withdrawals, age and the number of cigarettes smoked may successfully predict AWS. In conclusion, the results of this analysis allow for origination of further research, which should include additional biological and psychosocial parameters as well as consumption behaviour.

Biological markers for alcohol withdrawal seizures: a retrospective analysis

AIMS

Alcohol withdrawal seizures (AWS) are among the most important possible complications during the detoxification treatment of alcohol-dependent patients. Pharmacological therapy is often used during detoxification, but can cause dangerous side effects [Eur Addict Res 2010;16:179-184]. In separate studies several biological markers have been described as being associated with AWS risk. We investigated the role of homocysteine (HCT), carbohydrate-deficient transferrin (CDT) and prolactin (PRL) as biological markers for the risk of developing AWS.

METHODS

The present study included 189 alcohol-dependent patients of whom 51 had a history of AWS. We investigated the HCT, CDT and PRL levels of all patients and calculated sensitivity and specificity. Bayes' theorem was used to calculate positive (PPV) and negative (NPV) predictive values.

RESULTS

The highest combined sensitivity and specificity for %CDT was reached at a plasma cutoff value of 3.75%. The combination of HCT at a cutoff value of 23.9 μmol/l and %CDT at a cutoff value of 3.75% showed the best predictive values (sensitivity 47.1%, specificity 88.4%, PPV 0.504, NPV 0.870).

CONCLUSION

A combined assessment of HCT and CDT levels can be a useful method to identify patients at a higher risk of AWS, which may lead to a more individualized therapy.

Promoter specific methylation of the dopamine transporter gene is altered in alcohol dependence and associated with craving

Dopaminergic neurotransmission plays a crucial role in the genesis and maintenance of alcohol dependence. Epigenetic regulation via promoter specific DNA methylation of the dopamine transporter gene (DAT) may influence altered dopaminergic neurotransmission in alcoholism. Aim of the present study was to investigate DNA promoter methylation of DAT in early alcohol withdrawal and in relation to alcohol craving. We analyzed blood samples of 76 patients admitted for detoxification treatment and compared them to 35 healthy controls. Methylation specific quantitative real-time PCR was used to measure the promoter specific DNA methylation of the dopamine transporter. We assessed the extent of alcohol craving using the obsessive compulsive drinking scale (OCDS). Compared to healthy controls we found a significant hypermethylation of the DAT-promoter (Mann-Whitney U-test: p=0.001). Ln-transformed methylation of the DAT-promoter was negatively associated with the OCDS (linear regression: Beta=-0.275, p=0.016), particularly with the obsessive subscale (Beta=-0.300, p=0.008). Findings of the present study show that the epigenetic regulation of the DAT-promoter is altered in patients undergoing alcohol withdrawal. Furthermore, hypermethylation of the DAT-promoter may play an important role in dopaminergic neurotransmission and is associated with decreased alcohol craving.

The 3' part of the dopamine transporter gene DAT1/SLC6A3 is associated with withdrawal seizures in patients with alcohol dependence

BACKGROUND

Some studies have reported that the A9 allele of the variable nucleotide tandem repeat (VNTR) of the gene which encodes the dopamine transporter (DAT1/SLC6A3) is associated with alcoholism withdrawal symptoms such as alcohol withdrawal seizures (WSs), whereas others did not. We investigated whether polymorphisms within the DAT1 gene are associated with WS taking into account some of the confounding factors such as the severity of alcohol dependence.

METHODS

To further assess the role of this gene in WS, we genotyped the VNTR and 7 single nucleotide polymorphisms (SNPs) encompassing the DAT1 gene in a sample of 250 alcohol-dependent subjects (175 men and 75 women), of whom 24% exhibited WSs, taking into account the severity of alcohol dependence.

RESULTS

The VNTR is associated with an increased risk of WSs (odd ratio = 3.5; p = 0.019), even when controlling for confounding factors (p = 0.031). As 2 SNPs, in roughly the same location of the gene (namely rs27072 and rs27048), are also associated with WSs, it is possible that the initial association of the VNTR polymorphism was tagging a specific haplotype of this gene. Indeed, in our sample of alcohol-dependent patients, 2 haplotypes were associated with a significantly different risk of WSs.

CONCLUSIONS

The present study adds evidence for a significant role of the 3' part of the DAT1 gene in WS of alcohol-dependent patients, not only because it is in accordance with previous work, but also because of larger statistical power (as relying on a sample over sampled with the studied phenotype), as it gives a more precise analysis of different SNPs within the DAT1 gene, and as it confirms the association when major potentially confounding factors are taken into account in a logistical regression analysis.

Biological markers to predict previous alcohol withdrawal seizures: a risk assessment

Recent studies have shown that both, elevated homocysteine and prolactin plasma levels are associated with a higher risk of alcohol withdrawal seizures. The aim of this study was to evaluate the predictive qualities of a combined assessment of homocysteine and prolactin for previous alcohol withdrawal seizures. Therefore, 117 male patients suffering from alcohol dependency were included into the study. Homocysteine was measured directly at admission, prolactin the morning following admission for detoxification treatment. Pearson's chi(2)-test showed significant results for the combined assessment of both parameters (chi(2) = 14.71, p = 0.001). Multivariate logistic regression also revealed significant predictive qualities (p = 0.001, OR = 9.23, 95%CI = 2.36-36.05). A combination of both, homocysteine and prolactin, may help to assess the individual risk of alcohol withdrawal seizures in clinical practice.