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Kim HR, Kim SM, Kang WS, Jeon HJ, Jang SH, Jon DI, Hong J, Jeong JH. Development of a Guideline for Antipsychotic-induced Hyperprolactinemia in Korea Using the ADAPTE Process. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:447-456. [PMID: 37424413 PMCID: PMC10335910 DOI: 10.9758/cpn.22.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 07/11/2023]
Abstract
Objective To develop an evidence-based guideline for the diagnosis and treatment of antipsychotic-induced hyperprolactinemia by adapting existing high-quality clinical guidelines with a view to improve the clinical symptoms and long-term quality of life of patients by providing appropriate management. Methods This guideline was developed according to the ADAPTE methodology. The adaptation process included determining key health questions, systematically searching and screening guidelines, evaluating the quality and contents of these guidelines, deriving recommendations for key questions, and performing a peer review. The selection criteria for the guideline search were (1) evidence-based guidelines, (2) published within the last 5 years, and (3) written in English or Korean. Results After evaluating the quality and content, we finally selected three guidelines for adaptation. The final output of the development process was 25 recommendations for 10 key questions. We adopted the Agency for Health Research Quality methodology and presented the level of evidence from levels I to IV. In addition, we defined the recommendation grades from grade A (strongly recommended) to D (no recommendation) based on the level of evidence and clinical significance of the recommendation. Conclusion The development and dissemination of the adapted guideline is expected to increase the certainty of medical decision making and improve the quality of medical care. Further studies on the effectiveness and applicability of the developed guideline are necessary.
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Affiliation(s)
- Hye Ri Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won Sub Kang
- Department of Psychiatry, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Ho Jang
- Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jeongwan Hong
- Department of Psychiatry, Iksan Hospital, Iksan, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Matuszewska A, Kowalski K, Jawień P, Tomkalski T, Gaweł-Dąbrowska D, Merwid-Ląd A, Szeląg E, Błaszczak K, Wiatrak B, Danielewski M, Piasny J, Szeląg A. The Hypothalamic-Pituitary-Gonadal Axis in Men with Schizophrenia. Int J Mol Sci 2023; 24:6492. [PMID: 37047464 PMCID: PMC10094807 DOI: 10.3390/ijms24076492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Schizophrenia is a severe mental disorder with a chronic, progressive course. The etiology of this condition is linked to the interactions of multiple genes and environmental factors. The earlier age of onset of schizophrenia, the higher frequency of negative symptoms in the clinical presentation, and the poorer response to antipsychotic treatment in men compared to women suggests the involvement of sex hormones in these processes. This article aims to draw attention to the possible relationship between testosterone and some clinical features in male schizophrenic patients and discuss the complex nature of these phenomena based on data from the literature. PubMed, Web of Science, and Google Scholar databases were searched to select the papers without limiting the time of the publications. Hormone levels in the body are regulated by many organs and systems, and take place through the neuroendocrine, hormonal, neural, and metabolic pathways. Sex hormones play an important role in the development and function of the organism. Besides their impact on secondary sex characteristics, they influence brain development and function, mood, and cognition. In men with schizophrenia, altered testosterone levels were noted. In many cases, evidence from available single studies gave contradictory results. However, it seems that the testosterone level in men affected by schizophrenia may differ depending on the phase of the disease, types of clinical symptoms, and administered therapy. The etiology of testosterone level disturbances may be very complex. Besides the impact of the illness (schizophrenia), stress, and antipsychotic drug-induced hyperprolactinemia, testosterone levels may be influenced by, i.a., obesity, substances of abuse (e.g., ethanol), or liver damage.
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Affiliation(s)
- Agnieszka Matuszewska
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Krzysztof Kowalski
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Paulina Jawień
- Department of Biostructure and Animal Physiology, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 25/27, 50-375 Wroclaw, Poland
| | - Tomasz Tomkalski
- Department of Endocrinology, Diabetology and Internal Medicine, Tadeusz Marciniak Lower Silesia Specialist Hospital–Centre for Medical Emergency, A.E. Fieldorfa 2, 54-049 Wroclaw, Poland
| | - Dagmara Gaweł-Dąbrowska
- Department of Population Health, Division of Public Health, Wroclaw Medical University, Bujwida 44, 50-345 Wroclaw, Poland
| | - Anna Merwid-Ląd
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Ewa Szeląg
- Department of Maxillofacial Orthopaedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Karolina Błaszczak
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Benita Wiatrak
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Maciej Danielewski
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Janusz Piasny
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Adam Szeląg
- Department of Pharmacology, Wroclaw Medical University, J. Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
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Yakubu MT, Fayemo HT. Anti-hyperprolactinemic activities of aqueous extract of Uvaria chamae (P. Beauv) roots and associated biochemical changes in chlorpromazine-induced hyperprolactinemic female Wistar rats. JOURNAL OF ETHNOPHARMACOLOGY 2021; 271:113863. [PMID: 33485972 DOI: 10.1016/j.jep.2021.113863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/23/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARAMCOLOGICAL RELEVANCE The age-long folkloric use of Uvaria chamae roots in the management of nipple discharge that is not related to pregnancy, childbirth or nursing but as a result of excessive production of prolactin (hyperprolactinemia) is yet to be substantiated with scientific data. AIM OF THE STUDY This study investigated the anti-hyperprolactinemic activities of aqueous extract of Uvaria chamae roots (AEUCR) and associated biochemical changes in chlorpromazine (CPZ)-induced hyperprolactinemic female Wistar rats. MATERIALS AND METHODS A total of sixty female rats (207.40 ± 2.69 g) were assigned into 6 groups: A-F. Animals in Group A received 0.5 ml of distilled water only whilst the 7 days CPZ-treated female rats (to induce hyperprolactinemia) in groups B, C, D, E, and F also received distilled water, 2.5 mg/kg body weight of bromocriptine (reference drug), 0.71, 1.41 2.83 mg/kg body weight of AEUCR for 28 days. RESULTS AEUCR contained a total of 15 (75%) amino acids with seven (46.67%) being essential amino acids and eight (53.33%) as non-essential amino acids. Administration of CPZ increased (p < 0.05) the levels of prolactin and testosterone, and reduced (p < 0.05) the levels of estradiol, progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), dopamine, triiodothyronine (T3) and tetraiodothyroxine (T4). Chlorpromazine also increased the levels of serum urea, creatinine, total protein, albumin, globulin, bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) of the animals. In contrast, AEUCR significantly (p < 0.05) reduced the CPZ-induced increases in the levels of prolactin and testosterone, and increased the levels of CPZ-induced reduction in the progesterone, estradiol, FSH, LH, dopamine, T3 and T4. The AEUCR also reversed (p < 0.05) the CPZ-induced related increases in the levels of urea, creatinine, total protein, albumin, globulin, bilirubin, ALT, AST and ALP similar to the trends in the distilled water- and bromocriptine-treated controls. The CPZ-induced remarkable increase in the size of lactating alveolus and lactiferous duct distribution in the mammary gland were restored to normal tubule-alveolar female pattern mammary glands, composed of branching ducts and small alveoli budding off the ducts. CONCLUSION The study concluded that aqueous extract of Uvaria chamae root exhibited anti-hyperprolactinemic activity by restoring prolactin and dopamine levels and tubule-alveolar female pattern in female rats. It also ameliorated CPZ-induced changes in the liver and kidney function indices. This study justifies the folkloric use of Uvaria chamae root in the management of abnormal discharge by the nipples that is unrelated to pregnancy, childbirth and nursing.
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Affiliation(s)
- M T Yakubu
- Phytomedicine, Toxicology, Reproductive and Developmental Biochemistry Research Laboratory, Department of Biochemistry, University of Ilorin, Ilorin, Nigeria.
| | - H T Fayemo
- Phytomedicine, Toxicology, Reproductive and Developmental Biochemistry Research Laboratory, Department of Biochemistry, University of Ilorin, Ilorin, Nigeria.
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He S, Yu WJ, Wang X, Zhang L, Zhao N, Li G, Shen YF, Li H. Risk factors of hyperprolactinemia induced by risperidone and olanzapine and their correlations with plasma glucose and lipids. Gen Psychiatr 2020; 33:e100206. [PMID: 32695960 DOI: 10.1136/gpsych-2020-100206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background Hyperprolactinemia is a common adverse reaction in patients with schizophrenia who take antipsychotic drugs; it often leads to treatment non-compliance in patients and has an adverse effect on their prognosis. Aims This study aimed to explore the risk factors of elevated prolactin (PRL) caused by risperidone (RIS) and olanzapine (OLZ) and the relationship between PRL and fasting plasma glucose and lipids. Methods Patients with schizophrenia were divided into two groups: 264 patients who were taking RIS and 175 patients who were taking OLZ. These two groups were further divided according to serum PRL levels: an elevated PRL group (>30 ng/mL) and a normal PRL group (PRL ≤30 ng/mL). The demographics, medication dosage, fasting plasma glucose, total cholesterol and triglycerides were compared in the two groups. Logistic regression analysis was performed to explore the risk factors of elevated PRL levels. Results Compared with the OLZ group, the RIS group had a greater number of patients with elevated PRL (155/264 vs 58/175). Either the RIS or the OLZ group, the proportion of elevated PRL was greater in female patients (RIS: χ2=6.76, p=0.009; OLZ: χ2=12.98, p<0.001) and with higher doses of the related drugs (RIS: U=-3.73, p<0.001; OLZ: U=-2.31, p=0.021). In patients taking RIS, the elevated PRL subgroup took the drug for a longer period (U=-2.76, p=0.006) and had lower triglyceride levels (U=2.76, p=0.006). In patients taking OLZ, the elevated PRL subgroup had lower fasting plasma glucose levels (U=2.29, p=0.022). Logistic regression analysis showed that gender, dose and fasting glucose levels were significantly associated with elevated PRL levels (RIS: p=0.001, OLZ: p<0.001; RIS: p<0.001; OLZ: p=0.003; RIS: p=0.020, OLZ: p=0.001, respectively). Conclusion Compared with OLZ, RIS had a greater effect on PRL in patients with schizophrenia, and in patients with schizophrenia taking RIS or OLZ, gender and dose were significantly correlated with the PRL value. Moreover, the plasma glucose level of the group with elevated PRL was lower than that of the group with normal PRL. The results also showed that high serum PRL may be associated with a favourable glucose metabolic profile in patients with schizophrenia taking RIS or OLZ. Further studies are warranted to confirm this association. Trial registration number NCT02640911.
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Affiliation(s)
- Sidi He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Juan Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoliang Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zhao
- Shanghai Pudong New Area Mental Health Center, Shanghai, China
| | - Guanjun Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Feng Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huafang Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Vilar L, Vilar CF, Lyra R, Freitas MDC. Pitfalls in the Diagnostic Evaluation of Hyperprolactinemia. Neuroendocrinology 2019; 109:7-19. [PMID: 30889571 DOI: 10.1159/000499694] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/17/2019] [Indexed: 11/19/2022]
Abstract
An appropriate diagnostic evaluation is essential for the most appropriate treatment to be performed. Currently, macroprolactinemia is the third most frequent cause of nonphysiological hyperprolactinemia after drugs and prolactinomas. Up to 40% of macroprolactinemic patients may present with hypogonadism symptoms, infertility, and/or galactorrhea. Thus, the screening for macroprolactin is indicated not only for asymptomatic subjects but also for those without an obvious cause for their prolactin (PRL) elevation. Before submitting patients to macroprolactin screening and pituitary magnetic resonance imaging, one should rule out pregnancy, drug-induced hyperprolactinemia, primary hypothyroidism, and renal failure. The magnitude of PRL elevation can be useful in determining the etiology of hyperprolactinemia. PRL values >250 ng/mL are highly suggestive of prolactinomas and virtually exclude nonfunctioning pituitary adenomas (NFPAs) and other sellar masses as the etiology of hyperprolactinemia. However, they can also be found in subjects with macroprolactinemia, drug-induced hyper-prolactinemia or chronic renal failure. By contrast, most patients with NFPAs, drug-induced hyperprolactinemia, macroprolactinemia, or systemic diseases present with PRL levels <100 ng/mL. However, exceptions to these rules are not rare. Indeed, up to 25% of patients harboring a microprolactinoma or a cystic macroprolactinoma may also have PRL <100 ng/mL. Falsely low PRL levels may result from the so-called "hook effect," which should be considered in all cases of large (≥3 cm) pituitary adenomas associated with normal or mildly elevated PRL levels (≤250 ng/mL). The hook effect may be unmasked by repeating PRL measurement after a 1:100 serum sample dilution.
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Affiliation(s)
- Lucio Vilar
- Division of Endocrinology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil,
- Pernambuco Endocrine Research Center, Recife, Brazil,
| | | | - Ruy Lyra
- Division of Endocrinology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil
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Cloutier M, Greene M, Touya M, Gagnon-Sanschagrin P, Guerin A. A real-world analysis of healthcare costs and relative risk of hyperprolactinemia associated with antipsychotic treatments in the United States. J Med Econ 2018; 21:1183-1190. [PMID: 30188234 DOI: 10.1080/13696998.2018.1521415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS Antipsychotic medications are associated with an increased risk of hyperprolactinemia, but differ in their propensity to cause this complication. This study aimed to assess the economic burden of hyperprolactinemia, and to compare its risk among adult patients using atypical antipsychotics (AAs) with a mechanism of action associated with no/low vs high/moderate prolactin elevation. METHODS This retrospective cohort study was based on US Commercial and Medicaid claims databases. Healthcare costs were compared between matched hyperprolactinemia and hyperprolactinemia-free cohorts using a two-part model. Risk of hyperprolactinemia was compared between patients receiving AAs with a mechanism of action associated with no/low (no/low prolactin elevation cohort) vs high/moderate prolactin elevation (high/moderate prolactin cohort) using logistic regression. RESULTS In the commercially insured sample, compared to the hyperprolactinemia-free cohort (n = 499), the hyperprolactinemia cohort (n = 499) was associated with incremental total healthcare costs of $5,732 ($20,081 vs $14,349; p = .004), and incremental medical costs of $3,861 ($13,218 vs $9,357; p = .040), mainly driven by hyperprolactinemia-related costs. In the Medicaid-insured sample, compared to the hyperprolactinemia-free cohort, the hyperprolactinemia cohort was associated with incremental total healthcare costs of $10,773 ($30,763 vs $19,990; p = .004), and incremental medical costs of $9,246 ($20,859 vs $11,613; p = .004), mainly driven by hyperprolactinemia-related and mental health-related costs. The odds of hyperprolactinemia in the no/low prolactin elevation cohort were 4-5-times lower than that in the high/moderate prolactin elevation cohort (odds ratio =0.21; p < .001). LIMITATIONS Hyperprolactinemia may be under-reported in claims data. CONCLUSIONS Hyperprolactinemia is associated with substantial healthcare costs. AAs associated with no/low prolactin elevation reduce the risk of hyperprolactinemia by 4-5-times compared to AAs associated with moderate/high prolactin elevation. Treatment options with minimal impact on prolactin levels may contribute to reducing hyperprolactinemia burden in AA-treated patients.
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Affiliation(s)
| | - Mallik Greene
- b Otsuka Pharmaceutical Development & Commercialization, Inc. , Princeton , NJ , USA
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Mittal S, Prasad S, Ghosh A. Antipsychotic-induced hyperprolactinaemia: case studies and review. Postgrad Med J 2017; 94:226-229. [PMID: 29122927 DOI: 10.1136/postgradmedj-2017-135221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/04/2022]
Abstract
Antipsychotics are a known cause of hyperprolactinaemia and can be associated with significant health issues in short term and long term. The effects vary with gender and age of the individual and can contribute towards non-concordance and hence relapse in mental health of our patients. Clinicians need to educate the patients about this significant side effect of not only antipsychotic medications but other medications causing hyperprolactinaemia commonly prescribed in primary care.
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Affiliation(s)
- Shweta Mittal
- Consultant Psychiatrist, Department of Psychiatry, Bassetlaw Hospital, Nottinghamshire Healthcare NHS Foundation Trust, Worksop, UK
| | - Suveera Prasad
- Consultant Psychiatrist, Adult Mental Health Inpatient Unit, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | - Adwaita Ghosh
- Consultant Psychiatrist, Adult Mental Health Inpatient Unit, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
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The risks of overlooking the diagnosis of secreting pituitary adenomas. Orphanet J Rare Dis 2016; 11:135. [PMID: 27716353 PMCID: PMC5052978 DOI: 10.1186/s13023-016-0516-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/16/2016] [Indexed: 01/06/2023] Open
Abstract
Secreting pituitary adenomas that cause acromegaly and Cushing’s disease, as well as prolactinomas and thyrotroph adenomas, are uncommon, usually benign, slow-growing tumours. The rarity of these conditions means that their diagnosis is not familiar to most non-specialist physicians. Consequently, pituitary adenomas may be overlooked and remain untreated, and affected individuals may develop serious comorbidities that reduce their quality of life and life expectancy. Because many signs and symptoms of pituitary adenomas overlap with those of other, more common disorders, general practitioners and non-endocrinology specialists need to be aware of the “red flags” suggestive of these conditions. A long duration of active disease in patients with secreting pituitary adenomas is associated with an increased risk of comorbidities and reduced quality of life. Appropriate treatment can lead to disease remission, and, although some symptoms may persist in some patients, treatment usually reduces the incidence and severity of comorbidities and improves quality of life. Therefore, correct, early diagnosis and characterization of a pituitary adenoma is crucial for patients, to trigger timely, appropriate treatment and to optimize outcome. This article provides an overview of the epidemiology of hormonal syndromes associated with pituitary adenomas, discusses the difficulties of and considerations for their diagnosis, and reviews the comorbidities that may develop, but can be prevented, by accurate diagnosis and appropriate treatment. We hope this review will help general practitioners and non-endocrinology specialists to suspect secreting pituitary adenomas and refer patients to an endocrinologist for confirmation of the diagnosis and treatment.
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Hong GK, Payne SC, Jane JA. Anatomy, Physiology, and Laboratory Evaluation of the Pituitary Gland. Otolaryngol Clin North Am 2016; 49:21-32. [PMID: 26614827 DOI: 10.1016/j.otc.2015.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The pituitary gland functions prominently in the control of most endocrine systems in the body. Diverse processes such as metabolism, growth, reproduction, and water balance are tightly regulated by the pituitary in conjunction with the hypothalamus and various downstream endocrine organs. Benign tumors of the pituitary gland are the primary cause of pituitary pathology and can result in inappropriate secretion of pituitary hormones or loss of pituitary function. First-line management of clinically significant tumors often involves surgical resection. Understanding of normal pituitary physiology and basic testing strategies to assess for pituitary dysfunction should be familiar to any skull base surgeon.
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Affiliation(s)
- Gregory K Hong
- Division of Endocrinology, Department of Medicine, University of Virginia Health System, PO Box 801406, Charlottesville, VA 22908, USA
| | - Spencer C Payne
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia Health System, PO Box 800713, Charlottesville, VA 22908, USA
| | - John A Jane
- Department of Neurosurgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908, USA.
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Chen CY, Lane HY, Lin CH. Effects of Antipsychotics on Bone Mineral Density in Patients with Schizophrenia: Gender Differences. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:238-49. [PMID: 27489377 PMCID: PMC4977815 DOI: 10.9758/cpn.2016.14.3.238] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/06/2016] [Accepted: 02/11/2016] [Indexed: 12/19/2022]
Abstract
Low bone mineral density (BMD) and osteoporosis are common in patients with schizophrenia and detrimental to illness prognosis and life quality. Although the pathogenesis is not fully clear, series of studies have revealed factors related to low BMD such as life style, psychotic symptoms, medication use and the activity of bone absorption markers. It has been known that antipsychotic-induced hyperprolactinemia plays a critical role on decreased BMD. However, it remains uncertain whether the risk factors differ between men and women. According to the effect on prolactin, antipsychotics can be classified into two groups: prolactin-sparing (PS) and prolactin-raising (PR). Our previous study has demonstrated that clozapine which is among the PS antipsychotics is beneficial for BMD when compared with PR antipsychotics in women with chronic schizophrenia. We have also found that risks factors associated with low BMD are different between men and women, suggesting that gender-specific risk factors should be considered for intervention of bone loss in patients with schizophrenia. This article reviews the effects of antipsychotics use on BMD with particular discussion for the differences on gender and age, which implicate the alterations of sex and other related hormones. In addition, currently reported protective and risk factors, as well as the effects of medication use on BMD including the combination of antipsychotics and other psychotropic agents and other potential medications are also reviewed.
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Affiliation(s)
- Chien-Yu Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
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Perry BI, Goldring KJ, Menon SJ. Prolactin monitoring in the acute psychiatry setting. Psychiatry Res 2016; 235:104-9. [PMID: 26631582 DOI: 10.1016/j.psychres.2015.11.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
Abstract
Hyperprolactinaemia is a common side effect associated with psychotropic medication. Limited guidance on its monitoring and management results in inconsistency in practice due to individual clinical variability. A retrospective service evaluation study was conducted on all patients admitted to an acute psychiatric assessment unit in South Wales, United Kingdom, over one calendar year (n=524), to assess the prevalence and possible causes of hyperprolactinaemia, correlation with symptomatology and monitoring and management by clinicians. The prevalence of hyperprolactinaemia in this population (n=67, 13%) was higher than in the general population. The most common association was medication (n=39, 58%), particularly Risperidone (n=19). Illicit substance use (n=10, 15%), and physical conditions (n=12, 18%) may also have contributed. However, only 44 (66%) received follow-up for their hyperprolactinaemia. There was a statistically significant difference in the sample means of those that did receive follow-up and those who did not, suggesting a degree of bias in patients selected to receive follow-up. These findings suggest that hyperprolactinaemia is relatively common in patients with mental illness, and that comprehensive guidelines need to be established for the monitoring and management thereof.
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Affiliation(s)
- Benjamin I Perry
- Caludon Centre University Hospital of Coventry, Warwickshire Clifford Bridge Road Walsgrave, Coventry CV2 2TE, United Kingdom.
| | - Katie J Goldring
- Prince Charles Hospital, Gurnos Estate Merthyr Tydfil CF47 9DT, United Kingdom.
| | - Sharmila J Menon
- Admissions Ward, Mental Health Unit Cwm Taf University Health Board Royal Glamorgan Hospital Ynysmaerdy, Pontyclun Mid Glamorgan, South Wales CF72 8XR, United Kingdom.
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Zamani Z, Zare S, Sadrkhanlou R, Ahmadi A, Movahed E. The Effects of Chlorpromazine on Reproductive System and Function in Female Rats. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:371-9. [PMID: 26644861 PMCID: PMC4671389 DOI: 10.22074/ijfs.2015.4553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
Background Chlorpromazine (CPZ), an antipsychotic drug, is associated with increased
risk of sexual dysfunction through increasing prolactin levels. The current study evaluates the effect of CPZ-induced hyperprolactinemia on ovarian follicular growth, gonadotropins, and alteration of ovarian source hormones. Materials and Methods In this experimental study, animals were divided into four
groups, control and CPZ (n=8 per group). In the treated groups, CPZ was administered
by gavage at doses of 3, 10 and 30 mg/kg per day for 28 days. On day 29 the animals
were killed after which histopathological and histomorphometric analyses of the ovaries
were performed. We evaluated the levels of prolactin serum, luteinizing hormone (LH),
follicle-stimulating hormone (FSH), estradiol (E2) and progesterone. Results The ovaries of the test groups showed numerous atretic follicles of various
sizes. CPZ caused a significant difference between the test groups and the control group
(P<0.05) on the amount of atresia and the size of the normal corpora lutea (CL). The increased dysfunction of the ovaries from the different groups depended on the amount of
CPZ administered. The serum concentrations of prolactin and progesterone significantly
increased (P<0.05), while the serum concentrations of estradiol, LH and FSH notably
decreased (P<0.05), depending on the CPZ dose. CPZ-induced animals had unsuccessful
mating and decreased pregnancy rate. Conclusion The present findings suggest that CPZ-induced disturbances not only depend
on prolactin level but the increased prolactin level is largely dose-dependent.
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Affiliation(s)
- Zahra Zamani
- Department of Biology, Faculty of Science , Urmia University, Urmia, Iran
| | - Samad Zare
- Department of Biology, Faculty of Science , Urmia University, Urmia, Iran
| | - Rajabali Sadrkhanlou
- Laboratory of Embryology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Abbas Ahmadi
- Laboratory of Embryology, Department of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Elham Movahed
- Department of Biology, Faculty of Science , Urmia University, Urmia, Iran
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Mandrioli R, Protti M, Mercolini L. Evaluation of the pharmacokinetics, safety and clinical efficacy of ziprasidone for the treatment of schizophrenia and bipolar disorder. Expert Opin Drug Metab Toxicol 2014; 11:149-74. [PMID: 25483358 DOI: 10.1517/17425255.2015.991713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Multiple strategies exist for the pharmacological treatment of schizophrenia and related disorders. In the last 20 years, several 'new' compounds have been introduced, called 'atypical antipsychotics', which have higher efficacy and better tolerability than first-generation neuroleptics. Among them, ziprasidone (ZPR) is currently finding widespread use, and it has also been shown to be active as an augmenter in bipolar disorder therapy. AREAS COVERED This review aims to provide the latest information on ZPR, an 'atypical' agent for the pharmacological therapy of schizophrenia and bipolar disorder. A literature search has been carried out with the keywords 'ziprasidone', 'schizophrenia', 'psychosis', 'bipolar', 'pharmacokinetics' and 'clinical trials'. In this process, particular attention has been paid to the drug pharmacokinetic characteristics and its safety in clinical use. EXPERT OPINION ZPR shares most advantages and disadvantages with other atypical antipsychotics. However, it can be useful for its low tendency to cause metabolic syndrome and hyperprolactinaemia, especially in patients suffering from excess weight, hyperlipidaemia, diabetes or who have suffered from hyperprolactinaemia when using other antipsychotics. However, there are serious doubts as to whether ZPR should be administered to patients suffering from arrhythmias or QTc prolongation, and even more for administration to bipolar patients undergoing polypharmacy with antidepressants.
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Affiliation(s)
- Roberto Mandrioli
- Alma Mater Studiorum - University of Bologna, Department for Life Quality Studies (QuVi) , Corso d'Augusto 237, 47921 Rimini , Italy +39 0541 434624 ; +39 0541 434608 ;
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Majumdar A, Mangal NS. Hyperprolactinemia. J Hum Reprod Sci 2014; 6:168-75. [PMID: 24347930 PMCID: PMC3853872 DOI: 10.4103/0974-1208.121400] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/19/2013] [Accepted: 08/09/2013] [Indexed: 11/12/2022] Open
Abstract
Prolactin (PRL) is an anterior pituitary hormone which has its principle physiological action in initiation and maintenance of lactation. In human reproduction, pathological hyperprolactinemia most commonly presents as an ovulatory disorder and is often associated with secondary amenorrhea or oligomenorrhea. Galactorrhea, a typical symptom of hyperprolactinemia, occurs in less than half the cases. Out of the causes of hyperprolactinemia, pituitary tumors may be responsible for almost 50% of cases and need to be investigated especially in the absence of history of drug induced hyperprolactinemia. In women with hyperprolactinemic amenorrhea one important consequence of estrogen deficiency is osteoporosis, which deserves specific therapeutic consideration. Problem in diagnosing and treating hyperprolactinemia is the occurrence of the ‘big big molecule of prolactin’ that is biologically inactive (called macroprolactinemia), but detected by the same radioimmunoassay as the biologically active prolactin. This may explain many cases of very high prolactin levels sometimes found in normally ovulating women and do not require any treatment. Dopamine agonist is the mainstay of treatment. However, presence of a pituitary macroadenoma may require surgical or radiological management.
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Affiliation(s)
- Abha Majumdar
- Departments of Obstetrics and Gynecology, Sir Ganga Ram Hospital and Sir Ganga Ram Kolmet Hospital, New Delhi, India
| | - Nisha Sharma Mangal
- Departments of Obstetrics and Gynecology, Sir Ganga Ram Hospital and Sir Ganga Ram Kolmet Hospital, New Delhi, India
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Ajmal A, Joffe H, Nachtigall LB. Psychotropic-Induced Hyperprolactinemia: A Clinical Review. PSYCHOSOMATICS 2014; 55:29-36. [DOI: 10.1016/j.psym.2013.08.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
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Schmidt M, Sofronescu A, Short B, Nahas Z, Zhu Y. Increased prolactin concentrations in a patient with bipolar disorder. Clin Chem 2013; 59:473-5. [PMID: 23449699 DOI: 10.1373/clinchem.2011.176925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew Schmidt
- Department of Psychiatry, University of South Carolina, Charleston, SC 29425, USA
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17
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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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A randomized open-label comparison of the impact of aripiprazole versus risperidone on sexual functioning (RAS study). J Clin Psychopharmacol 2011; 31:523-5. [PMID: 21720224 DOI: 10.1097/jcp.0b013e318222bb29] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Mandrioli R, Mercolini L, Lateana D, Boncompagni G, Raggi MA. Analysis of risperidone and 9-hydroxyrisperidone in human plasma, urine and saliva by MEPS-LC-UV. J Chromatogr B Analyt Technol Biomed Life Sci 2011; 879:167-73. [DOI: 10.1016/j.jchromb.2010.11.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/23/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
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Madhusoodanan S, Parida S, Jimenez C. Hyperprolactinemia associated with psychotropics--a review. Hum Psychopharmacol 2010; 25:281-97. [PMID: 20521318 DOI: 10.1002/hup.1116] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Different classes of psychotropics can cause hyperprolactinemia to varying degrees. Among antipsychotics, typical agents and risperidone are the most frequent and significant offenders. In this review we discuss the pathophysiology, offending medications, assessment and management of hyperprolactinemia. METHODS We did a literature review between 1976 and 2008 using PubMed, MEDLINE, PsychINFO and Cochrane database. Search terms used were prolactin, hyperprolactinemia, psychotropics, antipsychotics, typical antipsychotics, atypical antipsychotics, antidepressants and SSRIs. RESULTS Prolactin elevation is more common with antipsychotics than with other classes of drugs. Typical antipsychotics are more prone to cause hyperprolactinemia than atypical agents. Management options include discontinuation of offending medication, switching to another psychotropic, supplementing concurrent hormonal deficiencies and adding a dopamine agonist or aripiprazole. CONCLUSION Clinicians need to be alert about the potential for hyperprolactinemia and its manifestations with these medications. Prolactin levels need to be monitored and other causes of hyperprolactinemia ruled out in suspected cases.
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Joffe H, Hayes FJ. Menstrual cycle dysfunction associated with neurologic and psychiatric disorders: their treatment in adolescents. Ann N Y Acad Sci 2008; 1135:219-29. [PMID: 18574228 DOI: 10.1196/annals.1429.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Epilepsy, bipolar disorder, and migraines are common disorders that are often associated with disturbances in menstrual function in adolescent girls. Women with untreated epilepsy are more likely to have irregular menstrual cycles than are nonepileptic controls, indicating that the disease itself plays a role in the etiology of these reproductive abnormalities. In addition, many girls with these disorders require chronic maintenance treatment with agents that may perturb the hypothalamic-pituitary-ovarian axis. Valproate is a highly effective antiepileptic drug used widely to treat epilepsy, bipolar disorder, and migraines. Valproate induces features of the polycystic ovary syndrome (PCOS) in approximately 7% of women. Girls with epilepsy, and possibly bipolar disorder, appear particularly susceptible to developing PCOS features on valproate, perhaps on account of the relative immaturity of their hypothalamic-pituitary-ovarian axes. Antipsychotics are highly effective drugs used widely to treat adolescents with bipolar disorder, psychotic disorders, and behavioral disturbances. Some, but not all of the antipsychotic, induce hyperprolactinemia, which may result in oligo- or amenorrhea. Prolonged amenorrhea in association with hyperprolactinemia incurs significant risks for bone health in adolescent girls. Because of the potential reproductive health risks associated with use of specific antiepileptic drugs and selective antipsychotics, these agents are vital treatments for adolescents with severe illnesses. Use of these agents should be considered and weighed against the risk of using alternative agents, which have their own side effects, or not treating these serious neurologic and psychiatric disorders.
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Affiliation(s)
- Hadine Joffe
- Perinatal and Reproductive Psychiatry, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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22
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Abstract
Medications commonly cause hyperprolactinemia and their use must be differentiated from pathologic causes. The most common medications to cause hyperprolactinemia are the antipsychotic agents, although some of the newer atypical antipsychotics do not do so. Other medications causing hyperprolactinemia include antidepressants, antihypertensive agents, and drugs which increase bowel motility. Often, the medication-induced hyperprolactinemia is symptomatic, causing galactorrhea, menstrual disturbance, and erectile dysfunction. In the individual patient, it is important differentiate hyperprolactinemia due to a medication from a structural lesion in the hypothalamic-pituitary area. This can be done by stopping the medication temporarily to determine if the prolactin (PRL) levels return to normal, switching to another medication in the same class which does not cause hyperprolactinemia (in consultation with the patient's physician and/or psychiatrist), or by performing an MRI or CT scan. If the hyperprolactinemia is symptomatic, management strategies include switching to an alternative medication which does not cause hyperprolactinemia, using estrogen/testosterone replacement, or cautiously adding a dopamine agonist.
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Affiliation(s)
- Mark E Molitch
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Lee BH, Kim YK. The relationship between prolactin response and clinical efficacy of risperidone in acute psychotic inpatients. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:658-62. [PMID: 16466670 DOI: 10.1016/j.pnpbp.2005.11.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2005] [Indexed: 11/27/2022]
Abstract
Hyperprolactinemia can be induced by dopamine D2 receptor-binding drugs such as antipsychotic drugs. The author investigated the relationship between changes in prolactin (PRL) and clinical efficacy of risperidone. In this study, 27 acute psychotic inpatients completed a 12-week trial of risperidone. At baseline and at 2, 4, 8, and 12 weeks after beginning medication, the author measured PRL, assessed hyperprolactinemia-related symptoms, and administered the Brief Psychotic Rating Scale (BPRS). Risperidone treatment significantly elevated serum PRL level (range: 26.9 ng/ml-320.0 ng/ml). The increases of PRL in females were higher than males. The changes in serum PRL levels were not significantly correlated with the improvements in total BPRS scores. PRL-related symptoms such as irregular menstruation, galactorrhea, or erectile dysfunction occurred in nine subjects (7 females and 2 males) whose serum PRL levels increase very highly after 2 weeks of risperidone. In conclusion, our study suggests that the changes in serum PRL levels were not significantly correlated with clinical efficacy of risperidone.
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Affiliation(s)
- Bun-Hee Lee
- Department of Psychiatry, Korea University Ansan Hospital, College of Medicine, 516 Go-Jan Dong, Ansan City, Kyunggi-Do 425-020, South Korea
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Abstract
Medication use is a common cause of hyperprolactinemia, and it is important to differentiate this cause from pathologic causes, such as prolactinomas. To ascertain the frequency of this clinical problem and to develop treatment guidelines, the medical literature was searched by using PubMed and the reference lists of other articles dealing with hyperprolactinemia due to specific types of medications. The medications that most commonly cause hyperprolactinemia are antipsychotic agents; however, some newer atypical antipsychotics do not cause this condition. Other classes of medications that cause hyperprolactinemia include antidepressants, antihypertensive agents, and drugs that increase bowel motility. Hyperprolactinemia caused by medications is commonly symptomatic, causing galactorrhea, menstrual disturbance, and impotence. It is Important to ensure that hyperprolactinemia in an Individual patient is due to medication and not to a structural lesion in the hypothalamic/pituitary area; this can be accomplished by (1) stopping the medication temporarily to determine whether prolactin levels return to normal, (2) switching to a medication that does not cause hyperprolactinemia (in consultation with the patient's psychiatrist for psychoactive medications), or (3) performing magnetic resonance imaging or computed tomography of the hypothalamic/pituitary area. If the patient's hyperprolactinemia is symptomatic, treatment strategies include switching to an alternative medication that does not cause hyperprolactinemia, using estrogen or testosterone replacement, or, rarely, cautiously adding a dopamine agonist.
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Affiliation(s)
- Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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25
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Abstract
Hyperprolactinemia is increasingly prevalent in patients with common psychiatric disorders due to increasing prescriptions of antipsychotics, particularly newer atypical neuroleptics, in these patients. However, measurement of prolactin levels is indicated only in symptomatic patients. When hyper-prolactinemia is diagnosed, work-up should include exclusion of other causes of hyperprolactinemia, particularly those that might require treatment. Once such causes have been ruled out, a minority of patients with antipsychotic medication-induced hyperprolactinemia, including those with clinically significant signs and symptoms, will require treatment. When treatment is indicated, specifically when hyperprolactinemia results in amenorrhea in women or testosterone deficiency in men, dopamine agonist therapy is generally not advisable. Hormone-replacement therapy, which involves estrogen/progestogen in women and testosterone in men, can often prevent modification and interruption of successful psychiatric medication regimens.
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Affiliation(s)
- Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Delbello MP, Schwiers ML, Rosenberg HL, Strakowski SM. A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry 2002; 41:1216-23. [PMID: 12364843 DOI: 10.1097/00004583-200210000-00011] [Citation(s) in RCA: 251] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This randomized, double-blind, placebo-controlled study examined the efficacy and tolerability of quetiapine in combination with divalproex (DVP) for acute mania in adolescents with bipolar disorder. It was hypothesized that DVP in combination with quetiapine would be more effective than DVP alone for treating mania associated with adolescent bipolar disorder. Furthermore, it was hypothesized that quetiapine would be well tolerated. METHOD Thirty manic or mixed bipolar I adolescents (12-18 years) received an initial DVP dose of 20 mg/kg and were randomly assigned to 6 weeks of combination therapy with quetiapine, which was titrated to 450 mg/day (n = 15) or placebo (n = 15). Primary efficacy measures were change from baseline to endpoint in Young Mania Rating Scale (YMRS) score and YMRS response rate. Safety and tolerability were assessed weekly. RESULTS The DVP + quetiapine group demonstrated a statistically significantly greater reduction in YMRS scores from baseline to endpoint than the DVP + placebo group (F(1,27) = 5.04, p =.03). Moreover, YMRS response rate was significantly greater in the DVP + quetiapine group than in the DVP + placebo group (87% versus 53%; Fisher exact test, p =.05). No significant group differences from baseline to endpoint in safety measures were noted. Sedation, rated as mild or moderate, was significantly more common in the DVP + quetiapine group than in the DVP + placebo group. CONCLUSIONS The findings of this study indicate that quetiapine in combination with DVP is more effective for the treatment of adolescent bipolar mania than DVP alone. In addition, the results suggest that quetiapine is well tolerated when used in combination with DVP for the treatment of mania.
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Affiliation(s)
- Melissa P Delbello
- Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA.
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Abstract
Hyperprolactinaemia has been associated with a variety of side effects including amenorrhoea, galactorrhoea, sexual dysfunction, breast engorgement and osteoporosis. Since the mid-1970s, the impact of antipsychotics on human prolactin (hPrl) levels has been investigated. Baseline levels of hPrl were found to be similar in healthy controls and patients who were diagnosed as having schizophrenia. Short-term acute studies done after single parenteral or oral doses of phenothiazines found rapid two- to tenfold increases in hPrl. Similar increases were found in longer term studies that reported increases of three times in both men and women after 3 days that doubled again after several weeks of treatment. A study of longer term injectable fluphenazine enanthate found that elevation induced by a single injection lasted up to 28 days. The same results with significant increases have been reported with the butyrophenone, haloperidol. Substantial increases are found after single injections (up to nine times) and after weeks of treatment (up to three times sustained). Thus, early literature believed that there might be an association between these induced changes and response to therapy. However, prolactin is secreted by the anterior pituitary and is under inhibitory control of dopamine released from the tuberoinfundibular neurones. Thus, increases in prolactin are due to antipsychotic impact on tuberoinfundibular tract, one of four dopamine-related tracts. With the application of clozapine and other atypical antipsychotics, it was found that medications can successfully treat psychosis without increasing hPrl. In fact, early single-dose trails found clozapine to reduce hPrl by 16%. Later studies replicated this result and also found that up to 6 weeks of administration led to reductions in hPrl of up to 80%. Risperidone, however, has been found to persistently elevate hPrl in studies, despite its impact on other receptor sites. Olanzapine, quetiapine and ziprasidone have all been found to have little effect or produce decreases in hPrl. Most recently, aripiprazole, in early studies, appears to produce significant reductions in hPrl while maintaining therapeutic efficacy for psychosis.
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Affiliation(s)
- Paul J Goodnick
- Department of Psychiatry & Behavioural Sciences, University of Miami School of Medicine, 1400 NW 10 Avenue, Ste 304A, Miami, FL 33136, USA.
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Segraves RT. Female sexual disorders: psychiatric aspects. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:419-25. [PMID: 12085676 DOI: 10.1177/070674370204700502] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This manuscript reviews the current information concerning female sexual dysfunction that is relevant to general psychiatric practice. METHOD Research identified by the key words sexual dysfunction and prevalence, comorbidity, psychiatric drugs, or pharmacotherapy is reviewed. RESULTS Epidemiologic studies indicate that approximately 30% of female subjects between ages 18 and 59 years have sexual complaints of at least 3 months' duration in the past year. A high comorbidity with other psychiatric syndromes exists. Many psychiatric drugs are associated with sexual dysfunction. Drug treatments for female sexual dysfunction are being investigated. CONCLUSION Knowledge concerning the treatment of female sexual dysfunction is important to the general psychiatric clinician.
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Affiliation(s)
- Robert Taylor Segraves
- Department of Psychiatry, Case Western Reserve School of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA.
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Abstract
Atypical antipsychotics offer significant improvements over older, conventional antipsychotic agents. However, recently the newer agents have been linked to medical morbidity including hyperglycaemia, diabetes mellitus, bodyweight gain and abnormal lipid levels. Even more concerning, because of a significant risk of death, there have been numerous case reports of patients treated with clozapine or olanzapine developing diabetic ketoacidosis shortly after initiation of the drug. Much of the information concerning the medical morbidity of diabetes mellitus is based on case reports, retrospective chart reviews, naturalistic studies and cross-sectional studies. While definitive studies have yet to be reported, mounting evidence suggests that the atypical antipsychotic agents, particularly clozapine and olanzapine, may significantly impair glucose metabolism and increase the risk of diabetes in patients with schizophrenia. Diabetic ketoacidosis, although it appears to be uncommon, is of great concern secondary to the risk of death. Patients treated with atypical antipsychotic agents should be routinely screened for diabetes and other metabolic abnormalities including raised lipid levels. Patients with risk factors for diabetes should be monitored more closely. Reports and clinical experience suggest that in a case of atypical antipsychotic-associated diabetes or diabetic ketoacidosis, discontinuation of the antipsychotic agent may result in complete resolution of the hyperglycaemia and diabetes.
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Affiliation(s)
- David C Henderson
- Psychotic Disorders and Schizophrenia Research Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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