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Background Dopamine agonists such as bromocriptine and cabergoline have been found to be an effective treatment for hyperprolactinemia, not only inducing adenoma shrinkage but also lowering serum prolactin levels. Among known dopamine agonists, cabergoline is the drug of choice due to its enhanced tolerability compared with bromocriptine. This study aimed to evaluate cabergoline's effectiveness, along with transsphenoidal surgery, in the treatment of hyperprolactinemia. Methods We retrieved all patients with a diagnosis of prolactinoma who were treated in our hospital during 2000-2018. A total of 208 patients were enrolled in the analysis after applying exclusion criteria. Patients were divided into four groups according to the treatments received. The demographic data, dosage and duration of cabergoline, and serum prolactin levels at different time points were collected for analysis. Results Normalization was achieved in 59 patients (83.10%) within a short median duration of 2.80 months among those treated with cabergoline only. Although cabergoline alone was effective and well-tolerated, our data showed that long-term remission rates were more favorable when surgery was involved. The long-term remission rate of all patients enrolled was 53.8% (112 patients among 208 patients). The long-term remission rates for the different treatment groups were 17.8% (8 of 45 patients) in Group 1 (Operation→Drug), 83.3% (5 of 6 patients) in Group 2 (Drug→Operation), 79.0% (68 of 86 patients) in Group 3 (Operation only), and 43.7% (31 of 71 patients) in Group 4 (Drug only). Conclusion Cabergoline has been demonstrated to be effective and should be considered as a first-line treatment for hyperprolactinemia. In our study, transsphenoidal surgery was also demonstrated to achieve good results compared with medical treatment. Surgical intervention may resurface as an alternative first-line treatment. When used in combination with cabergoline, surgery offers a higher disease remission rate than either drug or operation alone.

Purpose To explore relationships between fatigue, depression, stress, and infection in the postpartum. Study design and methods This was a cross-sectional, correlational design with a sample of 119 new mothers at 4 to 6 weeks postpartum. Mothers completed fatigue, mood, and stress instruments as well as maternal and infant infection checklists. Morning blood and hindmilk (in breastfeeders) samples were collected. ELISA was used to measure prolactin, cortisol, melatonin, and secretory IgA (sIgA). Correlations between psychosocial, health, and biologic variables were explored. Results Fatigue was correlated with symptoms of infection in both mothers and babies, with perceived stress and postpartum stress as well as with depression. Serum prolactin was inversely associated with depression. Milk sIgA was related to milk prolactin and inversely related to stress. Milk melatonin and prolactin were inversely related, and fatigue scores were correlated with melatonin and inversely with prolactin. Clinical implications The data suggest that fatigue, stress, depression, and infection are related in postpartum mothers and that these relationships extend to levels of serum hormones and milk factors. It is possible that a cycle is established that multiplies the effects of fatigue when mothers experience stress and that this cycle of stress and fatigue may lead to immune deficits and infectious illnesses.

Since the initial paper by Trimble in 19781 highlighting postictal levels of serum prolactin as a way to separate epileptic from nonepileptic seizures, PubMed has logged approximately 300 articles retrievable by the search terms “epilepsy” and “prolactin.” Despite this considerable body of work, the role of serum prolactin in diagnosis of seizures remains uncertain. In this issue of Neurology® Clinical Practice , Abubakr and Wambacq2 evaluated serum prolactin levels 20 minutes after a behavioral seizure–like event in 200 patients undergoing video-EEG recordings in an epilepsy monitoring unit. Using the video-EEG as the “gold standard,” they found prolactin to be elevated in all 22 patients with tonic-clonic seizures, 27 of 32 patients with complex partial seizures, and 42 of 146 patients with psychogenic seizures. For tonic-clonic seizures sensitivity was 100% and for complex partial seizures sensitivity was 84.4%. Overall, elevated prolactin occurred in 84.4% of patients with epileptic events and 28.8% of patients with nonepileptic events. Sensitivity and specificity in this study were comparable to the pooled sensitivity (52.6%) and specificity (92.8%) for all epileptic seizures in a previously published American Academy of Neurology Therapeutics and Technology Assessment Subcommittee review of 10 studies.3

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

The efficacy and safety of bromocriptine mesylate (5 to 7.5 mg per day for up to 24 weeks) were studied in 22 clinical trials involving 226 patients who had amenorrhea/galactorrhea associated with hyperprolactinemia and no demonstrable pituitary tumor. Of the 187 patients evaluated for efficacy, 80% experienced reinitiation of menses (or pregnancy without first having menses); the average treatment time (excluding those who conceived) was 5.7 weeks. Galactorrhea was significantly (at least 75%) reduced in 76% of the 187 patients after an average treatment tome of 6.4 weeks, and was completely suppressed in 58% after 12.7 weeks. Maximum reduction in serum prolactin levels occurred within the first 4 weeks of therapy and the reduced levels were maintained during treatment; moreover, there was a strong correlation between prolactin reduction and clinical improvement. Adverse reactions were reported by 68% of the 226 patients evaluated for safety; in general, these reactions were mild and transient. Several patients experienced hypotension, but only 1 discontinued therapy because of it. Based on these findings, bromocriptine mesylate was judged safe and efficacious for this purpose.

Cyproterone acetate was given to patients with stages C and D prostatic cancer and its effect on endocrine parameters was studied. At a daily oral dose of 100 mg. cyproterone acetate induced marked reduction in the size and consistency of tumor, while it caused moderate suppression of serum luteinizing hormone, follicle-stimulating hormone and testosterone levels. Elevation of serum prolactin levels was observed after treatment with cyproterone acetate but was to a lesser degree than that caused by estrogens.

An analysis of 235 patients with galactorrhea (5.5 per cent males) showed that 20 per cent of all patients, and 34 per cent of women with associated amenorrhea, had radiologically evident pituitary tumors; these patients had the highest serum prolactin concentrations. The largest single group (32 per cent) consisted of women with idiopathic galactorrhea without amenorrhea; prolactin was normal in 86 per cent of these cases. Five patients had the empty-sella syndrome. Prolactin response was tested in selected patients by thyrotropin-releasing hormone, chlorpromazine, L-dopa, 24-hour sampling and other means. Tests with thyrotropin-releasing hormone were most useful in identifying patients with pituitary tumors. Surgery and radiotherapy lowered prolactin to a similar degree in patients with tumor, but galactorrhea, and amenorrhea often persisted after treatment. The ergot derivatives, bromergocryptine and lergotrile mesylate, lowered prolactin in all 18 patients with idiopathic hyperprolactinemia or pituitary tumor, stopped galactorrhea in over 50 per cent, restored menses in over 70 per cent, and allowed pregnancy in three.

Serum prolactin and oestradiol levels were measured in 183 children who were staged for pubertal development. Mean serum prolactin levels are higher in girls than in boys at stage 3 of pubertal development. In girls prolactin levels rise at stage 2, and are higher after menarche; in boys there is no change in prolactin levels. In this study serum oestradiol correlates with prolactin in the girls, but not in the boys.

Elevated levels of serum prolactin in patients with pituitary tumors have been associated with hypogonadism, frequently manifested in men as impotence and/or loss of libido. The purpose of our study was to test the hypothesis that psychogenic and/or organic impotence may be a manifestation of a relative hyperprolactinemic state. We studied 30 men with the known diagnosis of impotence: 17 organic and 13 psychogenic. There were 11 normal, sexually active men used as controls. Serum prolactins were determined with the radioimmunoassay technique. There were no significant differences in serum prolactin levels among control, organic impotent and psychogenic impotent groups. Impotence does not seem to be related to hyperprolactinemia in men in the absence of pituitary disease.

Long-term bromocriptine treatment was discontinued in thirty-seven women with hyperprolactinaemic amenorrhoea. After cessation of therapy thirty of the thirty-seven women became hyperprolactinaemic again with amenorrhoea or anovulatory bleeding. Seven of the women continued to have regular ovulatory menstruation but only three were normoprolactinaemic 3 months after stopping treatment. Two of the seven women had evidence of pituitary tumour regression. After the discontinuation they had nearly normal prolactin levels but during 2 years of follow up the serum prolactin levels slowly increased. In the twenty-seven women with pre treatment prolactin levels below 100 micrograms/I there was no difference between the prolactin levels before starting and 1 month after stopping treatment, while the women with pretreatment prolactin levels above 100 micrograms/l had lower levels after therapy. Bromocriptine treatment seldom results in permanent cure of hyperprolactinaemic amenorrhoea.

In immature male rats, receiving daily injections of bromocriptine (3 mg/kg bw), serum prolactin (Prl) remains low throughout development. In such hypoprolactinaemic males androgen variables are affected: a) the normally low pre-pubertal serum androgen (testosterone, dihydrotestosterone-T, DHT) is considerably increased, in correlation with a precocious development of the testicular Leydig cell population; b) the peri-pubertal rise of androgen is not prevented, but is is followed by significantly lower post-pubertal T, DHT levels, in correlation with moderately reduced Leydig cell counts and with strongly attenuated growth rates of sex accessory organs. Observed alterations of the post-natal androgen pattern cannot be related to LH changes since developmental LH values remained essentially unaltered. Results are in concordance with a marked age-dependent sensibility of androgen variables to a lack of Prl in the developing male.

An abrupt increment in serum prolactin (PRL) levels was demonstrated within 45 minutes of initiation of lunch at 1200 or 1400 h and supper at 1700 h. These observations establish that feeding triggers an acute release of PRL by the hypothalamic-pituitary unit.

We prospectively studied serum prolactin (PRL) elevation after different types of documented seizures in 17 patients. Marked PRL elevations above normal and above three times baseline were seen at 15 or 30 minutes after 20 of 25 (80%) generalized tonic-clonic, 13 of 30 (43%) complex partial, and 1 of 10 (10%) simple partial seizures. Although marked postictal PRL elevation is a sensitive indicator of recent epileptic seizures, a normal 15- or 30-minute postictal PRL level does not exclude an epileptic seizure.

To assess possible persistent cerebral effects, we acquired EEG, measured serum prolactin, and administered cognitive and motor tests before and after transcranial magnetic stimulation of 30 healthy adults. We found no detrimental effects on EEG or test performance. A slight but statistically significant decline in serum prolactin lacked correlation with the extent of stimulation.