Hyperprolactinaemia - a problem in patients from the reproductive period to the menopause

Does Laterality in Breast Cancer still have the Importance to be Studied? A Meta-analysis of Patients with Breast Cancer

BACKGROUND

Breast cancer (BC) is one of the most common cancers in the world. Studies show that left-sided BC in pre and post-menopausal women leads to double the risk of worse morbidity and mortality and the reasons are uncertain. Finding the relationship between BC laterality and other possible risk factors can be advantageous for the prognosis of BC.

OBJECTIVE

This present study aimed to analyze the relationship between BC laterality and possible risk factors.

METHODS

A total of 6089 studies were screened. 23 studies from 1971 to 2021 met the inclusion criteria and were included in the meta-analysis. A pooled relative risk was generated via meta-analysis with a 95% confidence interval.

RESULTS

Left-side BC laterality was significant (p < 0.00001) in the women populations compared to the right side based on the pooled size with possible high-risk factors, including handedness, older women, body mass index, people with black skin, invasive type carcinoma, and estrogen receptor-negative BC. These findings suggest that there may be a complex interplay of genetic, environmental, and lifestyle factors that contribute to left-side BC laterality.

CONCLUSION

Results suggest an increased rate of BC on the left side, with high-risk factors contributing to BC laterality, which may be useful in predicting prognosis. This study provides significant insights into the relationship between high-risk factors and BC laterality. By identifying potential risk factors associated with left-side BC, it may be possible to improve the ability to predict prognosis and develop more targeted treatment strategies. This information could be particularly useful for healthcare providers and patients, as it may guide decisions regarding screening, prevention, and treatment, ultimately improving patient outcomes and reducing the overall burden of BC.

Dietary aflatoxin B1 and antimalarial-a lumefantrine/artesunate-therapy perturbs male rat reproductive function via pro-inflammatory and oxidative mechanisms

We investigated the impact of Coartem™ (COA) and aflatoxin B1 (AFB₁) on rats' hypothalamus, epididymis, and testis. Male rats were randomly grouped (n = 5 rats) and treated: control group (corn oil), AFB₁ (70 µg/kg), COA (5 mg/kg), COA + AFB₁ (5 + 0.035 mg/kg) and COA + AFB₁ (5 + 0.07 mg/kg) for 28 days. Blood samples were collected for serum prolactin, testosterone, follicle-stimulating and luteinising hormones (FSH and LH) assay upon sacrifice. The semen, hypothalamus, epididymis, and testes were harvested for morphological, biochemical, and histopathology determination of oxidative, inflammation stress, genomic integrity, and pathological alterations. Exposure to the COA and AFB₁ caused the cauda epididymal spermatozoa to display low motility, viability, and volume, with increased abnormalities. Hormonal disruption ensued in animals exposed to COA and AFB₁ alone or together, exemplified by increased prolactin, and decreased testosterone, FSH and LH levels. Treatment-related reduction in biomarkers of testicular metabolism-acid and alkaline phosphatases, glucose-6-phosphate dehydrogenase, and lactate dehydrogenase-were observed. Also, COA and AFB₁ treatment caused reductions in antioxidant (Glutathione and total thiols) levels and antioxidant enzyme (Catalase, superoxide dismutase, glutathione peroxidase, and glutathione-S-transferase) activities in the examined organs. At the same time, treatment-related increases in DNA damage (p53), oxidative stress (xanthine oxidase, reactive oxygen and nitrogen species and lipid peroxidation), inflammation (nitric oxide and tumour necrosis factor-alpha), and apoptosis (caspase-9, and -3) were observed. Chronic exposure to COA and AFB1 led to oxidative stress, inflammation, and DNA damage in male rats' hypothalamic-reproductive axis, which might potentiate infertility if not contained.

Pool vs single sample determination of serum prolactin to explore venipuncture associated stress induced variation

Stress is identified as a cause of transient hyperprolactinemia, whereas venipuncture is considered a source of stress for patient. The aim of this study was to investigate the association of venipuncture-induced stress with elevation of serum prolactin. This was a cross-sectional observational study conducted on a group of 150 outdoor patients visiting a tertiary care hospital. Serial sampling was performed by drawing venous blood at different time intervals (0, 30 and 60 min) by single venipuncture to measure serum prolactin to diagnose stress-induced hyperprolactinemia. The study was conducted in two phases, namely, Phase 1 and Phase 2, at different times. The Phase 1 results were divided into two groups: Group 1 (0 min) and Group 5 (pool prepared from samples collected at 0 + 30 + 60 min). Likewise, the results of Phase 2 were segregated into five groups; Group 1 (0 min), Group 2 (30 min), Group 3 (60 min), Group 4 (average of three groups), and Group 5 (pool from samples collected at 0 + 30 + 60 min). In both Phase 1 and Phase 2 of the study, there was a statistically significant (p = 0.0003 in Phase 1 and p = 0.02 in Phase 2) decrease in the mean prolactin (17.99 ± 24.76 ng/mL in Phase 1 and 19.61 ± 23.42 ng/mL in Phase 2) in the pooled samples (Group 5) in comparison to the mean prolactin (19.67 ± 27.69 ng/mL in Phase 1 and 21.06 ± 25.06 ng/mL in Phase 2) of the serum collected at 0 h (Group 1). There was no significant difference in the mean prolactin measured from the pooled samples and average prolactin calculated after individual testing from each sample collected at 0 h, 30 min and 60 min. Venipuncture-triggered fear and apprehension may result in transient hyperprolactinemia. In comparison to performing multiple testing on the samples collected at different time intervals and determining the mean, measurement of the analyte from the pooled serum is the better alternative as it can conserve both time and resources.

Evaluation of the acute, sub-chronic and chronic oral toxicity, genetic toxicity, and safety of a Lomens-P0

Extracts of Hordeum vulgare and Chrysanthemum zawadskii, two traditional herbal medicines, have long been used to treat women's diseases. Our previous studies have confirmed that these extracts could help relieve the symptoms of premenstrual syndrome by inhibiting prolactin release. A mixture of these natural products was named Lomens-P0. In this study, we conducted three genotoxicity tests (bacterial reverse mutation, mammalian chromosome aberration, and mammalian erythrocyte micronucleus studies) and four oral toxicity tests (single-dose, 2-week repeated-dose, and 13-week repeated-dose studies in rodents, and a single-dose dose-escalation toxicity study in a non-rodent model) to confirm the potential toxicity and safety of Lomens-P0. The results of this series of tests indicated Lomens-P0 did not induce genotoxicity, and the NOAEL for the rodent was 2000 mg/kg BW/day. Similarly, no toxic effects were evident in the single-dose-escalation study in the non-rodent model. In conclusion, we confirmed that Lomens-P0 might have potential utility as a raw material for nutraceuticals and natural medicines.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43188-021-00090-5.

The Expression of Prolactin Receptors in Benign Breast Tumors Is Not Associated with Serum Prolactin Level

The role of prolactin (PRL) and its receptors in the initiation and development of benign breast tumors (BBT) has not been sufficiently studied. An imbalance in the system of hormone homeostasis is crucial in the development of BBT. In particular, an association between elevated prolactin levels and the development of BBT has been reported. Our study showed no significant differences between PRL receptor (PRL-R) expression in BBT tissue under normal and elevated serum PRL levels. There was also no significant correlation between age, PRL-R expression in BBT tissue, intact tissue, and PRL level in the serum. There was a strong significant correlation (p < 0.01; r = 0.92) between PRL-R expression in BBT samples and intact breast tissue, which did not depend on the serum PRL level. There was also no significant difference in the expression of the proliferative marker Ki-67 in BBT tissues from women with normal and elevated levels of serum PRL (p > 0.05). No signs of PRL and its receptors were detected in the BBT cystic fluid women with elevated serum PRL levels. In summary, our prospective study showed that the expression of PRL-R in the tissue of BBT and physiological breast tissue does not depend on the level of serum PRL.

Lomens-P0 (mixed extracts of Hordeum vulgare and Chrysanthemum zawadskii) regulate the expression of factors affecting premenstrual syndrome symptoms

BACKGROUND/OBJECTIVES

Premenstrual syndrome (PMS) is a disorder characterized by repeated emotional, behavioral, and physical symptoms before menstruation, and the exact cause and mechanism are uncertain. Hyperprolactinemia interferes with the normal production of estrogen and progesterone, leading to PMS symptoms. Thus, we judged that the inhibition of prolactin hypersecretion could mitigate PMS symptoms.

MATERIALS/METHODS

Hordeum vulgare L. extract (HVE), Chrysanthemum zawadskii var. latilobum extract (CZE), and Lomens-P0 the mixture of these extracts were tested in subsequent experiments. The effect of extracts on prolactin secretion at the in vitro level was measured in GH3 cells. Nitric oxide and pro-inflammatory mediator expression were measured in RAW 264.7 cells to confirm the anti-inflammatory effect. Also, the hyperprolactinemic Institute for Cancer Research (ICR) mice model was used to measure extract effects on prolactin and hormone secretion and uterine inflammation.

RESULTS

Anti-inflammatory effects of and prolactin secretion suppress by HVE and CZE were confirmed through in vitro experiments (P < 0.05). Treatment with Lomens-P0 inhibited prolactin secretion (P < 0.05) and restored normal sex hormone secretion in the hyperprolactinemia mice model. In addition, extracts significantly inhibited the expression of pro-inflammatory biomarkers, including interleukin-1β, and -6, tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 (P < 0.01). We used high-performance liquid chromatography analyses to identify tricin and chlorogenic acid as the respective components of HVE and CZE that inhibit prolactin secretion. The Lomens-P0, which includes tricin and chlorogenic acid, is expected to be effective in improving PMS symptoms in the human body.

CONCLUSIONS

The Lomens-P0 suppressed the prolactin secretion in hyperprolactinemia mice, normalized the sex hormone imbalance, and significantly suppressed the expression of inflammatory markers in uterine tissue. This study suggests that Lomens-P0 may have the potential to prevent or remedy materials to PMS symptoms.

The Effects of Elaeagnus angustifolia L. on the Thyroid-Stimulating Hormone, Dehydroepiandrosterone-Sulfate, Prolactin and Cortisol Levels in Post-Menopausal Women: A Double-Blind, Randomized, and Placebo-Controlled Study

Menopause is the last menstrual period associated with a decline in ovarian steroid secretion and follicular loss. Hormone profile changes during menopause include a decrease in the production of estrogen, dehydroepiandrosterone (DHEA), and prolactin (PRL), and an increase in thyroid-stimulating hormone (TSH) and cortisol. Herbal medicines are considered as alternatives to hormone therapy. The studies on postmenopausal women have shown that Elaeagnus angustifolia L. (called "Senjed" in Persian) has some efficacy in improving sex hormone and lipid profiles, joint pain, and cardiovascular function, as the decrease in luteinizing hormone, low-density lipoprotein, and heart rate was significant. The aim of the present study was to evaluate the effects of E. angustifolia on TSH, DHEA-S, PRL, and cortisol levels and their ratios in postmenopausal women. It is assumed that the eventual effects of hormones on the brain and other tissues are determined by the balance between interdependent hormones. In the present randomized double-blinded placebo-controlled trial (https://en.irct.ir/search/result?query=IRCT20170227032795N4), fifty-eight postmenopausal women were randomly assigned to one of two medicinal herb (15 g of the whole E. angustifolia fruit powder) and placebo (7.5 g isomalt + 7.5 g cornstarch) groups. After 10 weeks of the treatment, the serum levels of TSH, DHEA-S, PRL, cortisol hormones, and their ratios were measured. The increase in the TSH, and cortisol levels, and cortisol/DHEA-S ratio and the decrease in prolactin and DHEA-S and the PRL/TSH, PRL/cortisol, and DHEA-S/TSH ratios after E. angustifolia consumption were significant only based on within-group but not on the between-group analysis. Based on between-group analyses, the changes in the hormone profile were not significant in the placebo group. According to Iranian tradition and folklore, E. angustifolia fruit is a symbol of female fertility. Therefore, its consumption is highly recommended to maintain health in the elderly, especially women. However, the observed outcomes about the effect of E. angustifolia on menopause were not completely in line with the Iranian folklore. E. angustifolia consumption did not significantly affect the hormone profile and ratios at the end of the ten-week trial, possibly due to the small sample size, short time, and the fact that our participants were postmenopausal women.

The association between hormones and antipsychotic use: a focus on postpartum and menopausal women

During the postpartum and menopausal periods of women's lives, there is a well-established and significant drop of circulating estrogens. This may be the reason why both these periods are associated with an increased risk for onset or exacerbation of psychiatric disorders. Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods. The aim of this narrative review is to summarize what is known about the association of hormones and antipsychotics in the postnatal period and at menopause. In the review, we focus on estrogen and oxytocin hormones and include, for the most part, only papers published within the last 10 years. Both estradiol and oxytocin have at various times been implicated in the etiology of postpartum disorders, and estrogens, sometimes combined with progesterone, have been tested as potential treatments for these conditions. The role of estradiol as an adjunct to antipsychotics in the prevention of postpartum relapses is currently controversial. With respect to oxytocin, studies are lacking. Psychosis in menopausal and postmenopausal women has been successfully treated with estrogens and selective estrogen-receptor modulators, mainly raloxifene, in addition to antipsychotics. Some symptoms appear to respond better than others. No oxytocin study has specifically targeted postmenopausal women. Because of feedback mechanisms, there is a theoretical danger of therapy with exogenous hormones interfering with endogenous secretion and disturbing the balance among inter-related hormones. When used with antipsychotics, hormones may also affect the metabolism and, hence, the brain level of specific antipsychotics. This makes treatment with antipsychotics plus hormones complicated. Dose, timing and route of intervention may all prove critical to efficacy. While much remains unknown, this literature review indicates that, within standard dose ranges, the combination of hormones and antipsychotics for postnatal and menopausal women suffering severe mental distress can be beneficial, and is safe.

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

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

Stress-Induced Hyperprolactinemia: Pathophysiology and Clinical Approach

While prolactin is most well known for its role in lactation and suppression of reproduction, its physiological functions are quite diverse. There are many etiologies of hyperprolactinemia, including physiologic as well as pathologic causes. Physiologic causes include pregnancy, lactation, sleep-associated, nipple stimulation and sexual orgasm, chest wall stimulation, or trauma. Stress is also an important physiologic cause of hyperprolactinemia, and its clinical significance is still being explored. This review will provide an overview of prolactin physiology, the role of stress in prolactin secretion, as well as the general clinical approach to hyperprolactinemia.

Prolactin selectively transported to cerebrospinal fluid from blood under hypoxic/ischemic conditions

Aim

The aim of this study was to determine and to verify the correlation between the amount of prolactin (PRL) levels in the blood and in the cerebrospinal fluid (CSF) by various causes of death as an indicator for acute hypoxia in autopsy cases. It is to confirm the cause of the change in prolactin level in CSF by in vitro system.

Materials and methods

In autopsy materials, the PRL levels in blood from the right heart ventricle and in the CSF were measured by chemiluminescent enzyme immunoassay, and changes in the percentage of PRL-positive cells in the pituitary gland were examined using an immunohistochemical method. Furthermore, an inverted culture method was used as an in vitro model of the blood-CSF barrier using epithelial cells of the human choroid plexus (HIBCPP cell line) and SDR-P-1D5 or MSH-P3 (PRL-secreting cell line derived from miniature swine hypophysis) under normoxic or hypoxic (5% oxygen) conditions, and as an index of cell activity, we used Vascular Endothelial Growth Factor (VEGF).

Results and discussion

Serum PRL levels were not significantly different between hypoxia/ischemia cases and other causes of death. However, PRL levels in CSF were three times higher in cases of hypoxia/ischemia than in those of the other causes of death. In the cultured cell under the hypoxia condition, PRL and VEGF showed a high concentration at 10 min. We established a brain-CSF barrier model to clarify the mechanism of PRL transport to CSF from blood, the PRL concentrations from blood to CSF increased under hypoxic conditions from 5 min. These results suggested that PRL moves in CSF through choroidal epithelium from blood within a short time. PRL is hypothesized to protect the hypoxic/ischemic brain, and this may be because of the increased transportation of the choroid plexus epithelial cells.