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Prolactin is a 23 kDa protein synthesised and released by lactotrophs located in the anterior pituitary gland. The main function of prolactin is the development of the mammary glands and the production and maintenance of milk secretion during pregnancy and lactation. Prolactin is present in 3 forms in the circulation monomeric, dimeric and macroprolactin which is one of the causes of variability between assay manufacturers. Although most assays have been standardised using the WHO's 3rd international standard there is still considerable variability between commercially available assays and as such laboratories need to establish their own reference intervals. Clinicians use reference intervals to distinguish between healthy and diseased individuals. Direct methods to establish reference intervals are expensive and time consuming and are impractical for most routine clinical laboratories. Indirect methods using the laboratories own data are more commonly used but also have drawbacks. Determination of reference intervals for prolactin is particularly difficult due to various physiological causes for variation in prolactin levels including age, sex and menopause. The presence of macroprolactin, its detection and methods for reporting its presence adds to reference interval determination complexity and harmonisation of these methods may improve clinical care. [ABSTRACT FROM AUTHOR]

Endometriosis and hyperprolactinaemia are conditions that might lead to infertility as a consequence. The aim of this article was to present the current knowledge about possible relationships between prolactin/hyperprolactinaemia and endometriosis-related infertility. Experimental studies on local prolactin acting as cytokine and relationship of prolactin and endometriotic tissue, as well as clinical studies on hyperprolactinaemia and endometriosis-related infertility suggest the possible role of prolactin in endometriosis-related infertility, but final proof is still missing and the exact pathogenesis of infertility in such cases is still under investigation. Novel strategies in the treatment of endometriosis-related infertility, based on its connection with prolactin such as the use of prolactin receptor antibodies and prolactin receptor antagonists, are under investigation, but adequate clinical studies have yet to be undertaken. [ABSTRACT FROM AUTHOR]

Abstract Background Acute retinal pigment epitheliitis (ARPE) is a rare, idiopathic and self-limiting disease. The article aims to present ARPE in a patient using D2 dopamine receptor agonists for the treatment of hyperprolactinemia. Case presentation A 28-year-old female during hyperprolactinaemia treatment suffered from a dyschromatopsia and a central visual field defect in the left eye. She noticed a deterioration of vision and discontinued the cabergoline administration. The woman had not been diagnosed with other chronic conditions and exhibited no symptoms of infection. Upon admission, the patient was subjected to a test for COVID-19, which was negative. The ophthalmological examination revealed a decrease in visual acuity to distance in the left eye, which amounted to 18/20 on the Snellen chart. A central scotoma was noted on the Amsler chart and a loss of pigment epithelium was visible on the fundus of the left eye. Fluorescein angiography showed a discrete window defect in the left one, with no signs of leakage. Optical coherence tomography (OCT) scans of the maculae revealed a characteristic change in the photoreceptor layer and retinal pigment epithelium (RPE) in the fovea in the left eye. The electrophysiological tests revealed decreased function of cells in macular region. A magnetic resonance imaging (MRI) of the head and orbits demonstrated an asymmetric pituitary gland without chiasm compression and discrete signal enhancement from the left optic nerve. The patient underwent observation during hospitalisation. She reported improved colour vision and a decreased scotoma in the centre of her visual field. In regular outpatient follow-ups, successive improvements in visual acuity, as well as a decreased RPE damage and outer photoreceptor layer loss during an OCT test were observed. Conclusions A case of ARPE is reported in a patient taking medications for hyperprolactinemia. The role of dopamine receptor antagonists in the photoreceptor function and causation of ARPE needs further evaluation.

Background: Hyperprolactinaemia among patients on antipsychotic medications is generally overlooked due to lack of outwardly visible symptoms, patient resistance to reporting because the symptoms are perceived as shameful, or to clinician’s insufficient knowledge. Aim: The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications. Setting: The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria. Methods: A total of 209 patients with schizophrenia were evaluated through a cross-sectional design and assayed for serum prolactin with ELISA Kits. Frequencies and percentages were tabulated for categorical variables. Variables with significant associations with hyperprolactinaemia on chi-square (p 0.05) were subjected to logistic regression analysis. Results: The prevalence of hyperprolactinaemia was 45.9% in all patients on antipsychotic medication. The prevalence because of the use of typical and atypical antipsychotics was 51.5% and 25.0%, respectively. Hyperprolactinaemia was significantly associated with typical antipsychotics (β = 0314, p = 0.002), high overall drug dosage (β = 2.340, p = 0.003), high-dose typical antipsychotics (β = 3.228, p = 0.000), twice daily dosing frequency (β = 2.751, p = 0.001) and polypharmacy (β = 1.828, p = 0.0024). Conclusion: The findings support that patients on typical, high-dose antipsychotic medications and polypharmacy have a high prevalence of hyperprolactinaemia. As hyperprolactinaemia is often undetectable, screening and patient psycho-education on the significance of the signs and symptoms of hyperprolactinaemia is required for necessary clinical intervention. Contribution: The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa.

Background: Vitex agnus castus (VAC), also known as chaste tree, is a plant from the Mediterranean area, Crimea, and central Asia. Its fruit has been used for more than 2500 years as phytotherapic agent. In the last century, VAC has been mostly used for the treatment of premenstrual syndrome (PMS), menstrual irregularities, fertility disorders, and symptoms of menopause. Since some degree of hyperprolactinaemia may be observed in patients with such disorders, VAC effects on hyperprolactinaemia have been assessed in a small number of studies and in some patient series or single case reports. It has been postulated that the diterpenes contained in VAC extract may interact with dopamine D2 receptors (D2R) and inhibit prolactin release via dopamine D2R activation in the anterior pituitary. Most of the published papers focus on the use of VAC for the management of PMS or infertility. However, due to its action on D2R, VAC could have a role in the treatment of mild hyperprolactinaemia, including patients with idiopathic hyperprolactinaemia, microprolactinoma, drug-induced hyperprolactinaemia, or polycystic ovary syndrome. Methods: We have reviewed and analysed the data from the literature concerning the use of VAC extracts in patients with hyperprolactinaemia. Results: Some evidence suggests a possible role of VAC for the management of hyperprolactinaemia in selected patients, though in an inhomogeneous way. However, there are not any large randomized controlled trials supporting the same and the precise pharmacological aspects of VAC extract in such a clinical setting still remain obscure. Conclusion: It appears that VAC may represent a potentially useful and safe phytotherapic option for the management of selected patients with mild hyperprolactinaemia who wish to be treated with phytotherapy. However, larger studies of high quality are needed to corroborate it. [ABSTRACT FROM AUTHOR]

Schizophrenia is a severe psychiatric disorder associated with significant comorbidities and early mortality. People with schizophrenia have a greater predisposition to the top 6 modifiable global mortality (cardiometabolic) risk factors as defined by the World Health Organization (compared with the general population). These are driven by genetic, lifestyle and disease factors, and obesogenic antipsychotic medications. Smoking, obesity and type 2 diabetes are the most important modifiable cardiometabolic risk factors for cardiovascular disease in people with schizophrenia. Enhanced physical health screening, especially for cardiometabolic risk factors, is recommended for people with schizophrenia. Enhanced physical health screening, especially for cardiometabolic risk factors, is recommended for people with schizophrenia. [ABSTRACT FROM AUTHOR]

Background Heart failure concomitant with prolactinoma is extremely rare. Case summary We present the case of a 29-year-old man who had acute decompensated heart failure concomitant with visual loss in his right eye. Transthoracic echocardiography indicated severely decreased left ventricular (LV) function. A massive tumour on the sella turcica was detected by brain computed tomography. The findings of the laboratory tests showed hyperprolactinaemia with hypopituitarism, and the antigen test for coronavirus disease 2019 was positive as an incidental finding. Medication for heart failure and cabergoline therapy were started immediately. His LV function significantly improved, and he had no symptoms after a year. Discussion Prolactinoma in men, which can cause visual loss and hypopituitarism, is frequently substantial when diagnosed. The cardiac manifestation of prolactinoma is uncommon. It is believed that a major contributing component to the pathogenesis of peripartum cardiomyopathy is hyperprolactinaemia. Hyperprolactinaemia may cause endothelial damage and cardiomyocyte dysfunction, eventually resulting in LV dysfunction. The success of LV reverse remodelling may be significantly impacted by heart failure and hormone treatments. Heart failure and endocrine therapy should be administered concurrently to patients who have prolactinoma and congestive heart failure. [ABSTRACT FROM AUTHOR]

This article outlines the different endocrine conditions resultant from dysfunction of the thyroid, adrenal and anterior pituitary glands. The clinical conditions caused by hormonal excess and deficiency from each of these glands are discussed, as well as their investigations and management. [ABSTRACT FROM AUTHOR]

BackgroundVitex agnus castus (VAC), also known as chaste tree, is a plant from the Mediterranean area, Crimea, and central Asia. Its fruit has been used for more than 2500 years as phytotherapic agent. In the last century, VAC has been mostly used for the treatment of premenstrual syndrome (PMS), menstrual irregularities, fertility disorders, and symptoms of menopause. Since some degree of hyperprolactinaemia may be observed in patients with such disorders, VAC effects on hyperprolactinaemia have been assessed in a small number of studies and in some patient series or single case reports. It has been postulated that the diterpenes contained in VAC extract may interact with dopamine D2 receptors (D2R) and inhibit prolactin release via dopamine D2R activation in the anterior pituitary. Most of the published papers focus on the use of VAC for the management of PMS or infertility. However, due to its action on D2R, VAC could have a role in the treatment of mild hyperprolactinaemia, including patients with idiopathic hyperprolactinaemia, microprolactinoma, drug-induced hyperprolactinaemia, or polycystic ovary syndrome.MethodsWe have reviewed and analysed the data from the literature concerning the use of VAC extracts in patients with hyperprolactinaemia.ResultsSome evidence suggests a possible role of VAC for the management of hyperprolactinaemia in selected patients, though in an inhomogeneous way. However, there are not any large randomized controlled trials supporting the same and the precise pharmacological aspects of VAC extract in such a clinical setting still remain obscure.ConclusionIt appears that VAC may represent a potentially useful and safe phytotherapic option for the management of selected patients with mild hyperprolactinaemia who wish to be treated with phytotherapy. However, larger studies of high quality are needed to corroborate it.

Objectives: One of the causes of hyperprolactinaemia (HP) is drug-associated HP (DAHP). In this study, it was planned to investigate the frequency of DAHP. Methods: In this study, a retrospective review of 296 individuals referred to the endocrinology outpatient clinic between June 2013 and March 2018 due to elevated prolactin (PRL) was performed. Results: Of the 296 patients included in the study, 140 (47.3%) had HP (+), 80 (27.0%) had HP (-), 27 (9.1%) had DAHP and other causes (16.6%). The causes of DAHP were as follows; sulpiride in 7 (25.9%) patients, risperidone in 6 (22.2%), amisulpride in 4 (14.8%), domperidone in 3 (11.1%), haloperidol in 2 (7.4%), paliperidone, olanzapine, escitalopram, duloxetine and otilonium bromide in one patient each. PRL levels in the DAHP group were higher than in the HP (-) group (respectively; median 114.6 [interquartile range (IQR): 144.0], median 35 [IQR 37.3], p < 0.001). Patients with DAHP had an increased frequency of symptoms compared to the HP (-) group (oligomenorrhoea; 42.3%, 16.4%, p = 0.007, galactorrhoea; 53.8%, 30.1%, p = 0.028, respectively). PRL levels were higher and the frequency of clinical signs was higher in sulpiride than risperidone (PRL; median 195.0 [IQR 99.0], median 72.0 [IQR 57.9], p = 0.022, oligomenorrhoea; 100%, 20%, p = 0.010, respectively). Conclusions: One of the 3 most common causes of patients referred for HP is DAHP and the most common cause of DAHP is anti-psychotic drugs. Sulpiride causes a higher rate of elevated PRL and frequency of clinical findings compared to other drugs. [ABSTRACT FROM AUTHOR]

Background: Extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia are major side effects with the use of antipsychotic medications that impede treatment adherence leading to relapse, increased cost of care and rehospitalization among patients with schizophrenia on antipsychotic medications. The study aims to compare the prevalence of extra-pyramidal side effects (EPSE), sexual dysfunctions (SD) and hyperprolactinaemia (HPRL) among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine if any associations exist between extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia. Methodology: A cross-sectional hospital-based survey involving 209 patients with schizophrenia were interviewed with structured instruments for the assessment of sexual dysfunction, EPSE and the estimation of serum prolactin was done using Enzyme-linked Immunosorbent Assay. Frequencies and Chi-square analysis were used to compare differences in EPSE, SD & HPRL. Result: The study revealed non-statistically significant differences as a group between typical and atypical antipsychotic medication in terms of extra-pyramidal side effects, sexual dysfunction and hyperprolactinaemia. However, a significant association was observed when individual drugs were compared with haloperidol causing the highest frequency of hyperprolactinaemia (X2 = 14.9, P = 0.011). A significant relationship between sexual dysfunction and hyperprolactinaemia, sexual dysfunction and extra-pyramidal side effects as well as extra-pyramidal and hyperprolactinaemia was found when individual items for sexual functionin were used. Conclusion: The significant relationships between sexual dysfunction only in the domains of sexual desire and arousal with hyperprolactinaemia and extrapyramidal side effects as well as hyperprolactinaemia with extrapyramidal side effects point to a common anti-dopaminergic activity of antipsychotics via different pathways. Prospective studies among a larger sample of patients with schizophrenia are needed to unfold these relationships. [ABSTRACT FROM AUTHOR]

The prolactin receptor (PRLR) signals predominantly through the JAK2-STAT5 pathway regulating multiple physiological functions relating to fertility, lactation, and metabolism. However, the molecular pathology and role of PRLR mutations and signalling are incompletely defined, with progress hampered by a lack of reported disease-associated PRLR variants. To date, two common germline PRLR variants are reported to demonstrate constitutive activity, with one, Ile146Leu, overrepresented in benign breast disease, while a rare activating variant, Asn492Ile, is reported to be a ssociated with an increased incidence of prolactinoma. In contrast, an inactivating germline heterozygous PRLR variant (His188Arg) was reported in a kindred with hyperprolactinaemia, while an inactivating compound heterozygous PRLR variant (Pro269Leu/Arg171Stop) was identified in an individual with hyperprolactinaemia and agalactia. We hypothesised that additional rare germline PRLR variants, identified from large-scale sequencing projects (ExAC and GnomAD), may be associated with altered in vitro PRLR signalling activity. We therefore evaluated >300 previously uncharacterised non-synonymous, germline PRLR variants and selected 10 variants for in vitro analysis based on protein prediction algorithms, proximity to known functional domains and structural modelling. Five variants, including extracellular and intracellular domain variants, were associated with altered responses when compared to the wild-type receptor. These altered responses included loss- and gain-of-function activities related to STAT5 signalling, Akt and FOXO1 activity, as well as cell viability and apoptosis. These studies provide further insight into PRLR structure- function and indicate that rare germline PRLR variants may have diverse modulating effects on PRLR signalling, although the pathophysiologic relevance of such alterations remains to be defined. [ABSTRACT FROM AUTHOR]

Purpose: Hyperprolactinaemia has been proposed to play a role in breast lesions pathophysiology. Thus far, controversial results have been reported for the relationship between hyperprolactinaemia and breast lesions. Moreover, the prevalence of hyperprolactinaemia in a population with breast lesions is scarcely reported. We aimed to investigate the prevalence of hyperprolactinaemia in Chinese premenopausal women with breast diseases, and explore the associations between hyperprolactinaemia with different clinical characteristics. Methods: This was a retrospective cross-sectional study performed in the department of breast surgery of Qilu hospital of Shandong University. Overall, 1,461 female patients who underwent the serum prolactin (PRL) level assay before breast surgery from January 2019 to December 2020 were included. Patients were divided into two groups: before and after menopause. Data were analyzed using SPSS 18.0 software. Results: The results showed an elevated PRL level in 376 of the 1,461 female patients with breast lesions (25.74%). Furthermore, the proportion of hyperprolactinemia among premenopausal patients with breast disease (35.75%, 340/951) was significantly higher than among postmenopausal patients with breast disease (7.06%, 36/510). In premenopausal patients, the proportion of patients with hyperprolactinaemia and the mean serum PRL level were significantly higher in those diagnosed with fibroepithelial tumours (FETs) and in younger patients (aged < 35 years) than in those with non-neoplastic lesions and in those aged ≥ 35 years (both p < 0.05). Especially, the prolactin level exhibited steady ascending tendency for positive correlation with FET. Conclusion: Hyperprolactinaemia is prevalent in Chinese premenopausal patients with breast diseases, especially in those with FETs, which implies a potential association, to some extent, between the PRL levels in various breast. [ABSTRACT FROM AUTHOR]

Objective: To estimate the proportion of patients with persistent normoprolactinaemia following dopamine agonist (DA) withdrawal and to identify predictors of successful withdrawal in patients with hyperprolactinaemia. Design, patients, and measurements: A systematic review of observational eligible studies were identified by searching PubMed and Embase. The primary outcome was the proportion of patients with normoprolactinaemia after cessation of DA treatment. Secondary outcome included the proportion of patients with normoprolactinaemia after DA withdrawal using individual patient data. Risk of bias was assessed by using Newcastle‐Ottawa Scale. Pooled proportions were estimated using a random effects model in case I2 ≤ 75% or by reporting range of effects if I2 > 75%. Results: Thirty‐two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I2 = 84%). Heterogeneity was partly explained by age with more successful withdrawal in patients of higher age. Individual patient data analyses suggested that the proportion of patients with persistent normoprolactinaemia 6 months after DA withdrawal with a low maintenance dose and full regression of the prolactinoma was 87.7% (95% confidence interval [CI] = 60.7–97.1; I2 = 0%) and 58.4% (95% CI = 23.8–86.3; I2 = 75%) for microadenomas and macroadenomas, respectively. Conclusions: The proportion of patients with persistent normoprolactinaemia following DA withdrawal treatment varied greatly, partly explained by the mean age of participants of the individual studies. Individual patient data analysis suggested that successful withdrawal was likely in patients with full regression of prolactinomas using a low maintenance dose before cessation. [ABSTRACT FROM AUTHOR]

Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs. An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients. HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R2=0.05). HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities. [ABSTRACT FROM AUTHOR]

Background: Hyperprolactinaemia can cause infertility. Serum prolactin and clinical features of hyperprolactinaemia may vary between obese and non-obese infertile women. Identifying the differences may inform changes in the management of obese women with hyperprolactinaemia. This study aimed to compare the serum prolactin levels and the clinical features of hyperprolactinaemia in obese and non-obese infertile women in Kano., Methodology: This was a comparative cross-sectional study comprising 160 obese infertile women (study group) and another 160 non-obese infertile women (control group). Participants were recruited in the gynaecology clinics of Aminu Kano Teaching Hospital (AKTH) and Murtala Muhammed specialist Hospital (MMSH). Serum prolactin and clinical features of those with hyperprolactinaemia were analysed using SPSS 23. P-values ≤ 0.05 were considered significant. Odd ratios at 95% confidence were calculated., Results: The mean serum prolactin levels were 28.18 ± 10.53ng/ml and 17.50 ± 8.00 ng/ml in the obese and non-obese women respectively (P=0.0001). All categories of hyperprolactinaemia were more common (P=0.001) amongst the obese infertile women. The prevalence of hyperprolactinaemia was 37.5% and 18.1% in the obese and non-obese arms respectively (P=0.0001). However, 23.1% obese hyperprolactinaemic infertile women presented with galactorrhoea compared to 64.0% of the non-obese counterparts (P= 0.0001). Abnormal menstrual flow and galactorrhoea were observed more in moderate-markedly elevated serum prolactin level as seen in 65.2% and 69.6% respectively compared to those with mildly elevated serum prolactin level., Conclusion: Obese infertile women have higher baseline and prevalence of hyperprolactinaemia than their non-obese counterparts. However, non-obese hyperprolactinaemic infertile women presented more with galactorrhoea., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Nigerian Medical Association.)

Objective: The mechanism behind prolactin (PRL) elevation in stress-induced hyperprolactinemia (si-HP) in humans is unclear. This study aimed to investigate the effect of psychological stress and venous puncture (VP) pain on si-HP., Methods: The study included 91 individuals (9 males, 82 females) referred for HP. Anxiety levels were assessed using the Anxiety Sensitivity Index-3 (ASI-3) and the State-Trait Anxiety Inventory (STAI-1 and STAI-2), and visual scales were used to evaluate trypanophobia, nosocomephobia, and scanxiety. Serial PRL measurements were performed with venous cannula (VC) at 0 minute (min), 30 min, and 60 min for the first 32 patients and with the VP method at the same intervals for the following 59 patients. si-HP was defined as PRL levels at 60 min (PRL 60min) decreasing to normal limits according to gender., Results: There were 23 HP (-), 25 HP (+), and 19 si-HP individuals, as well as 24 with macroprolactinaemia. The frequency of si-HP in the VC group (n = 7/32) was similar to that in the VP group (12/59, P = .9). The prolactin levels at 0 minute (PRL0min) and prolactin levels at 60 minutes (PRL60min) levels of the VC group were similar to those of the VP group. Trypanophobia, nosocomephobia, scanxiety, ASI-3, STAI-1, and STAI-2 scale scores were similar between the si-HP group and other groups. Trypanophobia, nosocomephobia, scanxiety, ASI-3, STAI-1, and STAI-2 scales scores were not correlated with PRL0min or PRL60min levels., Conclusion: Si-HP is independent of states momentary or trait anxiety, and phobias trypanophobia, nosocomephobia and scanxiety. In this context, the relevance of the nomenclature of si-HP is controversial., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)

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Background: Prolactin has multiple biological functions and hyperprolactinaemia is a common condition in clinical practice in both females and males. It has many etiologies and may present with variable symptoms to health care workers. Aims and Objectives: To study the various etiologies and clinical presentation of patients presenting with hyperprolactinaemia in a tertiary care medical college and hospital in West Bengal to aid in quick decision management. Materials and Methods: The current study was a cross-sectional study with follow up conducted over a period of one year in the Department of Gynecology and Obstetrics, Jagannath Gupta Institute of Medical College and Hospital. Following sample size calculation, a total of 1824 women were enrolled for the study of which 53 were found to have raised prolactin level (after following proper inclusion and exclusion criteria) They were subsequently further examined and followed up. Results: Majority of the subjects studied belonged to 20-29 age group (49.05%) followed by 30-39 years age group (35.85%). The most common cause of hyperprolactinaemia in our study were idiopathic (24.53%) followed by drugs (22.64%) and pituitary adenoma. Most of the patients with hyperprolactinaemia, presented with complain of infertility (56.6%), menstrual abnormality (50.94%) and galactorrhoea (18.87%) in our study. Therapeutic drugs used for various reasons were one of the main cause of hyperprolactinaemia (22.64%) and mainly due to use of proton pump inhibitor with prokinetics use. Conclusion: Hyperprolactinaemia is very much common in patients with infertility, menstrual abnormality or galactorrhoea and mostly are due to idiopathic or drug induced causes. With early initiation of treatment most of the causes and effects can be cured.

Introduction: Sexual functioning has remained widely neglected aspect of patient care for those suffering from severe mental disorders and has received little attention. Yet, it has been construed as one of the major factors contributing to nonadherence with antipsychotic medications. Aim: To study sexual dysfunction in patients with psychotic disorders and its clinical association with serum prolactin levels. Materials and Methods: This case-control study was conducted in the Department of Psychiatry at MGM Medical College and associated Mental Hospital, Indore, Madhya Pradesh, India, from 13th February 2020 to 21st January 2021. The study sample consisted of 200 subjects including 100 cases and 100 controls. The case group included patients with a diagnosis of psychotic disorders currently in remission for atleast one month. Remission of the patients was ensured by Brief Psychiatric Rating Scale (BPRS) with a score of <4 on all items and <28 total score. Assessment of sexual dysfunction was done using Arizona Sexual Experience Scale (ASEX). The control group included healthy subjects aged between 18-65 years, either sex having active sexual partners with a score of <3 on all the items of the General Health Questionnaire (GHQ-12). Collection of blood sample was done and serum was analysed for prolactin levels using the Chemiluminescent Microparticle Immunoassay (CMIA) method. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 28.0 for windows. Results: The mean age of the case group was 39.9±7.457 years while that of the control group was 35.60±9.37 years. The number of male patients (71% and 73%) was higher than females (29% and 27%) in the control group and case group respectively. The difference between the two were statistically significant. The total number of cases who experienced sexual dysfunction came out to be 59 out of 100. Total 55.93% of those having sexual dysfunction were suffering from difficulty in sexual arousal, followed by difficulty with penile erection/vaginal lubrication (49.15%), orgasmic dysfunction (34.48%), and reduced sexual drive (23.72%). Among the cases, the mean serum prolactin level (14.14±10.60 ng/mL) was seen to be significantly higher (p-value <0.001) than the control group (9.46±6.05 ng/mL). Maximum serum prolactin level (29.00±9.95 ng/mL) was seen to be associated with usage of a combination of both 1st and 2nd generation antipsychotics. Conclusion: There was a significant prevalence of sexual dysfunction in psychotic patients and is associated significantly with elevated serum prolactin levels. [ABSTRACT FROM AUTHOR]

Introduction: Sexual functioning has remained widely neglected aspect of patient care for those suffering from severe mental disorders and has received little attention. Yet, it has been construed as one of the major factors contributing to non-adherence with antipsychotic medications. Aim: To study sexual dysfunction in patients with psychotic disorders and its clinical association with serum prolactin levels. Materials and Methods: This case-control study was conducted in the Department of Psychiatry at MGM Medical College and associated Mental Hospital, Indore, Madhya Pradesh, India, from 13th February 2020 to 21st January 2021. The study sample consisted of 200 subjects including 100 cases and 100 controls. The case group included patients with a diagnosis of psychotic disorders currently in remission for atleast one month. Remission of the patients was ensured by Brief Psychiatric Rating Scale (BPRS) with a score of

Background: The prevalence of hyperprolactinaemia in women presenting for infertility investigation has been found to be up to 17%, and many of these women are asymptomatic. Prolactin levels may be elevated by stress, including phlebotomy and not be of clinical significance. A cannulated prolactin study may be a useful way to discriminate this. Aim: To determine the utility of a cannulated prolactin series in women presenting with infertility who have a raised prolactin measurement at referral for first fertility consultation. Materials and Methods: All women referred to two fertility centres had a prolactin level measured prior to first appointment over a two‐year period. If the level remained elevated on the second measure after macroprolactin precipitation, women were referred for a cannulated prolactin series. If the prolactin concentration fell within the reference range during the series then the result was regarded as normal. Results: Forty‐four (2.7%) of 1660 women seen for a first specialist appointment had persistently raised prolactin concentrations after two samples and were referred for a cannulated series. The proportion of women whose prolactin was found to be normal during the cannulated prolactin series was 61% (95% CI 47–74%). Even in patients with a referral prolactin of greater than 1000 mU/L, 45% had a normal two‐hour cannulated series. Conclusion: A high proportion (61%) of women with raised prolactin at time of referral for first specialist appointment had a normal prolactin after a two‐hour cannulated series. A cannulated prolactin study can avoid unnecessary further investigations in these women. [ABSTRACT FROM AUTHOR]

Introduction: Macroprolactin, an immunoreactive molecule resulting from association of monomeric Prolactin (mPRL) and immunoglobulin G is a significant cause of misdiagnosis, unnecessary radiological investigation and treatment for hyperprolactinaemia. Data on its prevalence and clinical manifestation varies regionally. Case presentation can vary with assymptomatic cases to those with galactorrhea and irregular menses. Aim: To find the prevalence and clinical features associated with macroprolactin in cases of hyperprolactinaemia in hospital patients. Materials and Methods: A cross-sectional study was conducted in the Department of Biochemistry, Institute of Postgraduate Medical Education and Research and SSKM hospital, Kolkata, India, from November 2018 to April 2019. Serum samples were assayed for serum PRL levels in 1400 subjects by Chemiluminescence immunoassay (Immulite 1000 siemens) based on presenting symptoms of galactorrhoea, amenorrhoea and infertility. Serum PRL samples (n=240) above the manufacturer’s reference cut-off level (PRL ≥30 ng/ mL) were obtained from patients with or without symptoms of hyperprolactinaemia. Retesting for PRL levels were done following precipitation of macroprolactin using Polyethylene Glycol (PEG, MW: 6000). Fourty cases with physiological causes of PRL excess, hypothyroidism, polycystic ovary syndrome, antidopaminergic drug intake, hepatorenal diseases and chest wall disorders were excluded. The results were expressed in terms of Mean±Standard Deviation (SD) and compared using student t-test. Results: Prevalence of macroprolactin was 16 (13.3%) out of 120 among true hyperprolactaemic cases (male=2; female, n=14) based on percentage recovery of PRL in post-PEG cases (Recovery Rate (RR)

Background: Prolactin has multiple biological functions and hyperprolactinaemia is a common condition in clinical practice in both females and males. It has many etiologies and may present with variable symptoms to health care workers. Aims and Objectives: To study the various etiologies and clinical presentation of patients presenting with hyperprolactinaemia in a tertiary care medical college and hospital in West Bengal to aid in quick decision management. Materials and Methods: The current study was a cross-sectional study with follow up conducted over a period of one year in the Department of Gynecology and Obstetrics, Jagannath Gupta Institute of Medical College and Hospital. Following sample size calculation, a total of 1824 women were enrolled for the study of which 53 were found to have raised prolactin level (after following proper inclusion and exclusion criteria) They were subsequently further examined and followed up. Results: Majority of the subjects studied belonged to 20-29 age group (49.05%) followed by 30-39 years age group (35.85%). The most common cause of hyperprolactinaemia in our study were idiopathic (24.53%) followed by drugs (22.64%) and pituitary adenoma. Most of the patients with hyperprolactinaemia, presented with complain of infertility (56.6%), menstrual abnormality (50.94%) and galactorrhoea (18.87%) in our study. Therapeutic drugs used for various reasons were one of the main cause of hyperprolactinaemia (22.64%) and mainly due to use of proton pump inhibitor with prokinetics use. Conclusion: Hyperprolactinaemia is very much common in patients with infertility, menstrual abnormality or galactorrhoea and mostly are due to idiopathic or drug induced causes. With early initiation of treatment most of the causes and effects can be cured. [ABSTRACT FROM AUTHOR]

Objective: Guidelines stipulate that baseline prolactin be ordered prior to commencing antipsychotic treatment to facilitate investigation of any subsequent hyperprolactinaemic symptoms. The aim was to observe when and why prolactin levels are ordered for psychiatry inpatients commencing or continuing antipsychotics and how this alters clinical management.Methods: Psychiatry inpatients admitted to the Alfred Hospital, Melbourne, Australia, in 2018 with the diagnoses of psychosis, schizophrenia, schizo-affective disorder or bipolar affective disorder were retrospectively analysed. Results and clinical history data were collected in patients in whom prolactin was ordered during or within 12 months of the relevant admission.Results: Of 592 patients admitted during this period, 90 had prolactin ordered. Eight (8.9%) of the 90 tests were for hyperprolactinaemic symptoms, while the remainder were routine blood work. The results altered clinical management in 10 of the 90 (11.1%) patients. Of these 10, 8 were symptomatic. In the six patients with first episode psychosis, only one had prolactin ordered prior to antipsychotic commencement.Conclusions: Adherence to guideline recommendations of baseline prolactin testing was poor. When established on antipsychotics, measuring prolactin rarely changed management in asymptomatic patients; however, it did in those with hyperprolactinaemic symptoms. Measuring prolactin in asymptomatic patients on antipsychotics appears unhelpful. [ABSTRACT FROM AUTHOR]

This study assessed the association between serum prolactin (PRL) concentration and aggression in female patients with schizophrenia. Female patients with schizophrenia (N = 120) were diagnosed using SCID-5 based on the DSM-5 criteria. They were sampled at the University Psychiatric Hospital Vrapce during the period from March 2017 to March 2019. Aggression was evaluated using the Positive and Negative Syndrome Scale (PANSS), and Overt Aggression Scale (OAS). Patients were subdivided into aggressive and non-aggressive groups. PRL was determined in serum using electrochemiluminescence (ECLIA) method. Aggressive patients with schizophrenia had significantly (p < 0.0001) increased PRL concentration compared to non-aggressive patients. Higher PRL concentration was significantly (p < 0.0001) associated with pronounced aggressive symptoms determined by the OAS scores. When patients were subdivided into those who were treated with risperidone, haloperidol, paliperidone, amisulpride, and a group that was not treated with these antipsychotics, aggressive patients in both groups had significantly higher PRL concentrations than non-aggressive patients. Higher antipsychotic dose was related to increased PRL concentration (p = 0.004). Our findings suggest that higher PRL is significantly associated with aggression, irrespective of the antipsychotic medication, in female patients with schizophrenia. [ABSTRACT FROM AUTHOR]

The data presented in this paper describe supplementary material to the article entitled “Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia: a systematic review and meta-analysis” [1]. Although raw data was published on the original article, additional raw data has been included in the current paper (new tables with socio-demographic and clinical characteristics of the samples of the studies included in the systematic review). Supplementary data also include the PICO scheme of the systematic review, PRISMA checklist, flow diagram, an explanation of the method for obtaining prolactin concentrations from published figures when data was only available in figures, list of the selected studies, risk of bias summary of all five randomized clinical trials evaluating the addition of aripiprazole for lowering prolactin (included in the meta-analysis in the original article). Extra analyses, figures and R code of the meta-analysis have been also included. Meta-analysis of randomized clinical trials (RCTs) considering aripiprazole addition for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia were conducted with two softwares: 1) R and the metaphor package (for the meta-analysis of the primary outcome [prolactin reduction]); 2) MedCalc version 18.11 (for the meta-analysis of the secondary outcome [withdrawal rates]). Data from a sensitivity analysis (repeating the meta-analysis with only placebo-controlled RCTs) has been also included in the current article.

Risperidone is one of the most commonly used antipsychotic agents in the treatment of psychosis in children and adults. However, it can lead to hyperprolactinaemia by blocking dopamine D2 receptors in the anterior pituitary. This can result in galactorrhea, menstrual irregularity, amenorrhoea and gynaecomastia and can impact adversely on medication compliance and quality of life. Very few data are available in the literature concerning the management of hyperprolactinaemia developing in association with antipsychotics in children and adolescents. This report describes improvement with the addition to treatment of low-dose aripiprazole in hyperprolactinaemia and menstrual irregularity emerging as side effects of risperidone therapy in an adolescent girl diagnosed with schizophrenia.

Endocrine Medical Research center (EMRC) of the Ministry of health of Russia is unique clinical center, that have no analogs in the world. All forms of endocrine disorders may be diagnosed and treated here by implication of innovative methods. Institute of reproductive medicine of EMRC was open on 2017, director of this institute - MD, PhD E.N. Andreeva. Staff of this institute include highly experienced investigators and physicians. One of the most ambitious projects of the institute is development of prevention, diagnostic and treatment algorithm for patients with infertility of endocrine origin. For these purposes large prospective clinical trial (5000 patients) will be conducted with implementation of most modern genetic, laboratory and instrumental diagnostic methods. Results of this trial will allow diagnose, treat and prevent reproductive pathology in patients with endocrine diseases.

What is known and objective: Vitamin D administered together with selenomethionine has been reported to markedly reduce thyroid antibody titres in patients with autoimmune thyroiditis. Hyperprolactinaemia exerts a complex pro‐inflammatory effect. This study was aimed at investigating whether prolactin excess determines the effect of vitamin D/selenomethionine combination therapy on thyroid autoimmunity. Methods: The study included two age‐, body mass index‐, hormone‐ and thyroid antibody‐matched groups of young euthyroid women with Hashimoto's thyroiditis: 19 women with mild‐to‐moderate hyperprolactinaemia and 19 individuals with prolactin levels within the reference range. All participants were then treated with vitamin D (4000 IU daily) and selenomethionine (200 µg daily). Serum titres of thyroid peroxidase and thyroglobulin (TgAb) antibodies, serum levels of thyrotropin, free thyroxine, free triiodothyronine, prolactin and 25‐hydroxyvitamin D, as well as the calculated parameters of thyroid homeostasis, were determined at baseline and 6 months later. Results and discussion: All women completed the study. With the exception of prolactin and 25‐hydroxyvitamin D levels, there were no differences between the study groups in the investigated parameters. In both study groups, vitamin D/selenomethionine combination therapy reduced thyroid peroxidase and TgAb antibody titres, decreased the free thyroxine:free triiodothyronine ratio and increased 25‐hydroxyvitamin D levels and SPINA‐GD. The decrease in antibody titres, as well as the improvement in vitamin D status, was more pronounced in subjects with prolactin levels within the reference range than in subjects with hyperprolactinaemia and was inversely correlated with prolactin levels. Moreover, only in normoprolactinaemic women, the treatment reduced thyrotropin levels and increased SPINA‐GT. What is new and conclusion: The obtained results suggest that hyperprolactinaemia attenuates the impact of vitamin D/selenomethionine combination on thyroid autoimmunity. [ABSTRACT FROM AUTHOR]

Purpose: Moderate hyperprolactinaemia (2–5 times upper limit of normal) occurring in a patient with a normal pituitary MRI is generally considered to be due to a lesion below the level of detection of the MRI scanner assuming macroprolactin and stress have been excluded. Most patients with mild-to-moderate hyperprolactinaemia and a normal MRI respond to dopamine agonist therapy. We present the rare case of a patient who had prolactin elevation typical of a prolactin-secreting pituitary macroadenoma,with a normal cranial MRI, and in whom the prolactin rose further with dopamine agonist treatment. Subsequent investigations revealed ectopic hyperprolactinaemia to a uterine tumor resembling ovarian sex cord tumor (UTROSCT) which resolved following tumor resection. Although mostly considered to be benign, the UTROSCT recurred with recurrent hyperprolactinaemia and intraabdominal metastases. Methods: We have systematically and critically reviewed existing literature relating to ectopic hyperprolactinaemia in general and UTROCST specifically. Results: Fewer than 80 cases of UTROSCTs have been reported globally of which about 23% have shown malignant behaviour. There are fewer than 10 cases of paraneoplastic hyperprolactinaemia originating from uterine neoplasms including one other case of ectopic hyperprolactinaemia to a UTROSCT. Conclusions: Our case demonstrates the importance of screening for extracranial hyperprolactinaemia in the context of: (1) substantially raised prolactin (10× ULN) and (2) normal cranial MRI assuming macroprolactin has been excluded. The majority of extracranial ectopic prolactin-secreting tumors occur in the reproductive organs. [ABSTRACT FROM AUTHOR]

Background: Determination of the efficacy of treatment of hyperprolactinemia developed on the background of primary hypothyroidism in women with reproductive disorders is of great medical importance. Aim: To determine effectiveness of performed treatment with thyroxine in women with hyperprolactinemia developed on the background of primary hypothyroidism and determination of correlations between prolactin and other hormones before and after treatment in women with hyperprolactinemia developed on the background of primary hypothyroidism. Methods: Prospective cohort study was conducted at the Center for Reproductive Medicine "Universe" and the clinic "Medhealth" during 2016-2018. Study involved 52 untreated women with hyperprolactinemia developed on the background of primary hypothyroidism. Medical history was analyzed with each of them. Objective investigations were conducted. Prolactin (PRL), thyroid stimulating hormone (TSH), free thyroxine (FT4), anti-thyroid peroxidase (anti-TPO), follicle stimulating hormone(FSH), luteinizing hormone (LH), estradiol (E2), total testosterone (TT), free testosterone (FT) and progesterone were studied in blood serum in dynamics with immunoassay analysis (ELISA) method. Ultrasound examination of pelvic organs and thyroid gland was performed. In all cases, L-thyroxine was used continuously to treat hyperprolactinemia with dose adjustment in dynamics. In patients with whom despite stable compensation of hypothyroidism, prolactin levels were not normalized, dopamine agonist (bromocriptine) was included in the treatment along with continued thyroxine administration. Results:The mean levels of PRL and TSH before treatment were significantly high compared to the reference indicators (p<0.05). Anti-TPO mean levels (p<0.05) were also significantly high compared to the reference rates, while the E2 and progesterone mean levels were significantly lower (p <0.05). Prior to treatment, there was no significant difference between mean FT4, FSH, LH, TT, FT and reference rates (p> 0.05). After the treatment PRL, TSH, and anti-TPO significantly reduced; E2, progesteron significantly increased; FT4, FSH, LH, TT, FT remained within reference rates. Conclusions: Continuous treatment with thyroxine normalized prolactin levels, regulated the menstrual cycle and restored ovulation in patients with mild hyperprolactinemia developed on the background of primary hypothyroidism, which accounted for 88.9% of the women involved in the study. Despite stable compensation of hypothyroidism achieved with thyroxine replacement therapy, no normalization of prolactin levels was observed in 11.1% of patients with moderate hyperprolactinemia developed on the background of primary hypothyroidism and a dopamine agonist was included in the treatment, after which the prolactin level normalized, menstrual cycle regulated and ovulation restored. Prior to treatment, significant positive correlation of prolactin with TSH and significant negative correlation with E2 and Progesterone was detected in women with hyperprolactinemia developed on the background of primary hypothyroidism. Significant correlation of prolactin with FT4, anti-TPO, FSH, LH, TT and FT was not detected. After the treatment significant correlation was determined only between prolactin and TSH. [ABSTRACT FROM AUTHOR]

Introduction: Hyperprolactinaemia, a common adverse effect of antipsychotic drugs, is primarily linked to blockade of dopamine D2 receptors in the pituitary gland. Certain antipsychotic drugs, such as, for example risperidone and paliperidone, are more likely to induce hyperprolactinaemia compared to others. This effect is probably caused by a relatively high blood/brain concentration ratio, a consequence of being a substrate of P‐glycoprotein. Genetic variants of P‐glycoprotein with changed functional activity might influence the potential of risperidone and paliperidone to cause hyperprolactinaemia as the altered blood/brain concentration ratio would lead to a reduced therapeutic drug level within essential brain areas making dose adaptations necessary. This increases exposure of dopamine D2 receptors within the pituitary gland. Aims: To investigate possible associations between MDR1/ABCB1 gene polymorphisms and antipsychotic drug‐induced hyperprolactinaemia in Russian patients with schizophrenia and to determine possible differences between risperidone/paliperidone and other antipsychotics. Methods: In total, 446 patients with schizophrenia were included from 3 psychiatric hospitals in Siberia. Blood samples were obtained in a cross‐sectional study design for DNA extraction and prolactin measurement. Associations between hyperprolactinaemia and 8 MDR1/ABCB1 gene‐polymorphisms were assessed using logistic regression analysis accounting for covariates. The analysis was repeated in a patient subgroup using risperidone or paliperidone. Results: We did not observe an association between any of the 8 single nucleotide polymorphisms and the prevalence of antipsychotic‐induced hyperprolactinaemia in the total patient population. However, in the risperidone/paliperidone subgroup, the single nucleotide polymorphism rs2032582 (G2677T) was found to be negatively associated with risperidone/paliperidone‐induced hyperprolactinaemia. Conclusion: This study revealed a significant association between the ABCB1 gene polymorphism rs2032582 (G2677T) and risperidone/paliperidone‐induced hyperprolactinaemia. [ABSTRACT FROM AUTHOR]

Different therapeutic strategies are used for lowering prolactin concentrations in patients with psychotic disorders with antipsychotic-induced hyperprolactinaemia. We aimed to examine the evidence from open-label studies and randomized clinical trials (RCTs) that studied four prolactin-lowering therapeutic strategies in people with psychotic disorders and hyperprolactinaemia: 1) switching to prolactin-sparing antipsychotics; 2) adding aripiprazole; 3) adding dopamine agonists; and 4) adding metformin. RCTs were included in a meta-analysis. Effect sizes (Hedges' g) of prolactin reductions with each strategy were calculated. Withdrawal rates were also considered. We identified 26 studies. Nine studies explored switching antipsychotic treatment to aripiprazole (n = 4), olanzapine (n = 1), quetiapine (n = 2), paliperidone palmitate (n = 1) or blonanserin (n = 1). Twelve studies tested the addition of aripiprazole. Six studies explored the addition of cabergoline (n = 3), bromocriptine (n = 2) or terguride (n = 1). We also found one meta-analysis testing the addition of metformin to antipsychotic treatment but no other individual studies. A meta-analysis could only be performed for the addition of aripiprazole, the strategy with the best level of evidence. Five RCTs testing the addition of aripiprazole yielded a significant reduction in prolactin concentration compared to placebo (N = 3) or maintaining antipsychotic treatment (N = 2): Hedges' g was -1.35 (CI 95%: -1.93 to -0.76, p < 0.001). The three placebo-controlled RCTs for aripiprazole addition showed similar withdrawal rates for aripiprazole (10.1%) and placebo (11.5%), without significant differences in the meta-analysis. Our study suggests that, in terms of levels of evidence, adding aripiprazole is the first option to be considered for lowering prolactin concentrations in patients with schizophrenia and hyperprolactinaemia. [ABSTRACT FROM AUTHOR]

Hyperprolactinaemia is the occurrence of an endocrine disorder that leads to an increase in the level of the hormone prolactin (PRL) in the blood above normal levels in cases other than the natural increase in pregnancy and lactation. It may be present as the menstrual disturbances, galactorrhea, sexual dysfunction, gynecomastia, infertility, decreased bone mineral density, and breast cancer. This increase results from several causes that may be pathological such as pituitary tumors, psychological such as stress, or as a result of taking a specific drug such as schizophrenia, anti-vomiting drugs, nerve analgesics, first-generation antipsychotics, hypnotics, and sedatives. Hyperprolactinaemia by metoclopramide was induced in male and female rats to assess the therapeutic effects of alcoholic extracts of sage leaves, marjoram leaves and celery seeds. Through the biochemical analysis of blood hormones, the results showed that treating rats with metoclopramide drug (150 mg / kg / day) for a week had an effect on the positive control group in the occurrence of hyperprolactinaemia compared to the negative control group at the beginning of the experiment. The results indicated that there was a significant effect (P<0.05) for the three plant extracts namely marjoram leaves, sage leaves and celery seeds ( 250 mg / kg / day) for 30 days, to reduce the prolactin hormone in the blood and also to maintain the level of the rest of the sex hormones (progesterone (PRG), estrogen (E2), testosterone (TST), Follicle- stimulating hormone (FSH) and Luteinizing hormone (LH)) without causing any disturbance in males and females in comparison to the group of drug used in the experiment. To treat this condition bromocriptine (Dopamine receptors agonist) is used. The rats returned to normal case after the appearance of the rats’ recovery after taking the extracts during the trial period. This effect may be due to estrogen receptors and /or dopamine receptor. [ABSTRACT FROM AUTHOR]

Hyperprolactinaemia is one of the most frequent causes of anovulation, resulting in infertility and hypoestrogenic state with consequences on overall women’s health. Recent investigations on biological actions of prolactin, especially prolactin of extrapituitary origin, expand our knowledge on prolactin role in the human organism and open new questions connected with female reproductive function and treatment of female infertility. This article represents the review of current knowledge on prolactin physiology, etiopathogenesis, clinical features, assessment, differential diagnosis,and treatment of hyperprolactinaemia in the female patient. [ABSTRACT FROM AUTHOR]

Background: Risperidone is a widely used antipsychotic, known to cause secondary hyperprolactinaemia. Related problems include bone mineral density (BMD) and vitamin D deficiency. However, there is insufficient information about the extent, severity, and association between these side effects, particularly in the Asian population. Objectives: To estimate the prevalence of osteoporosis, and vitamin D deficiency in patients taking risperidone for more than one year. Also, to investigate whether erectile dysfunction (ED) or menstrual dysfunction (MD) can be used as a proxy indicator of BMD loss in such patients, replacing dual energy X-ray absorptiometry (DEXA) scan. Method: Sixty-five patients (mean age 29.6) receiving risperidone as the only prolactin raising medication for minimum period of one year were selected taking into consideration the socio-demographic and clinical variables. History of ED/ MD, DEXA measurement of their lumbar and hip bone, and endocrine variables were recorded. Results: The prevalence of hyperprolactinaemia in female was found to be 84.4% and in males 78.8%; females being 1.4 times more at risk than males. Abnormal BMD was found in more than 40% of the subjects. Furthermore, 30% had vitamin D deficiency and 60.8% had vitamin D insufficiency. A statistically significant association was observed between ED/ MD and BMD (odds ration [OR] 3.71, confidence interval [CI] 1.23-11.24, p=0.02), but this varied according to the gender. Conclusion: These results suggest that patients on long term risperidone are at high risk of developing hyperprolactinaemia, reduced BMD and Vitamin D, although multiple contributory factors or mechanisms can be suggested. Clinically, ED was more significantly associated with changes in BMD.

Summary Background Falsely elevated prolactin measurements risk overdiagnosis, and unnecessary imaging and treatment. Design We conducted a clinical audit of 18 patients who presented with hyperprolactinaemia, followed by a laboratory audit of 40 split samples across a range of serum prolactin (5‐5051 mIU/L). In each case (total n = 58), serum prolactin was measured on both Roche and Siemens platforms. Results Serum prolactin as measured by Roche was higher than the corresponding Siemens value in every case, despite similar reference ranges. The mean discrepancy in serum prolactin by Roche vs. Siemens was +81% in the clinical audit and +50% in the laboratory audit. This led to unnecessary interventions in 7/18 patients (39%) in the clinical audit. Conclusions Serum prolactin is overestimated on the Roche relative to the Siemens platform. Laboratories should review Roche reference intervals for serum prolactin, and clinicians should consider repeating serum prolactin on another platform if the serum prolactin is incongruent with the clinical scenario.

This is a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology on the role of echocardiography in monitoring patients receiving dopamine agonist (DA) therapy for hyperprolactinaemia. (1) Evidence that DA pharmacotherapy causes abnormal valve morphology and dysfunction at doses used in the management of hyperprolactinaemia is extremely limited. Evidence of clinically significant valve pathology is absent, except for isolated case reports around which questions remain. (2) Attributing change in degree of valvular regurgitation, especially in mild and moderate tricuspid regurgitation, to adverse effects of DA in hyperprolactinaemia should be avoided if there are no associated pathological changes in leaflet thickness, restriction or retraction. It must be noted that even where morphological change in leaflet structure and function may be suspected, grading is semi-quantitative on echocardiography and may vary between different machines, ultrasound settings and operators. (3) Decisions regarding discontinuation of medication should only be made after review of serial imaging by an echocardiographer experienced in analysing drug-induced valvulopathy or carcinoid heart disease. (4) A standard transthoracic echocardiogram should be performed before a patient starts DA therapy for hyperprolactinaemia. Repeat transthoracic echocardiography should then be performed at 5 years after starting cabergoline in patients taking a total weekly dose less than or equal to 2 mg. If there has been no change on the 5-year scan, repeat echocardiography could continue at 5-yearly intervals. If a patient is taking more than a total weekly dose of 2 mg, then annual echocardiography is recommended.

Background: Hyperprolactinaemia among patients on antipsychotic medications is generally overlooked due to lack of outwardly visible symptoms, patient resistance to reporting because the symptoms are perceived as shameful, or to clinician's insufficient knowledge., Aim: The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications., Setting: The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria., Methods: A total of 209 patients with schizophrenia were evaluated through a cross-sectional design and assayed for serum prolactin with ELISA Kits. Frequencies and percentages were tabulated for categorical variables. Variables with significant associations with hyperprolactinaemia on chi-square ( p < 0.05) were subjected to logistic regression analysis., Results: The prevalence of hyperprolactinaemia was 45.9% in all patients on antipsychotic medication. The prevalence because of the use of typical and atypical antipsychotics was 51.5% and 25.0%, respectively. Hyperprolactinaemia was significantly associated with typical antipsychotics (β = 0314, p = 0.002), high overall drug dosage (β = 2.340, p = 0.003), high-dose typical antipsychotics (β = 3.228, p = 0.000), twice daily dosing frequency (β = 2.751, p = 0.001) and polypharmacy (β = 1.828, p = 0.0024)., Conclusion: The findings support that patients on typical, high-dose antipsychotic medications and polypharmacy have a high prevalence of hyperprolactinaemia. As hyperprolactinaemia is often undetectable, screening and patient psycho-education on the significance of the signs and symptoms of hyperprolactinaemia is required for necessary clinical intervention., Contribution: The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa., Competing Interests: The authors have declared that no competing interest exist., (© 2024. The Authors.)

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Classic polycystic ovarian syndrome (PCOS) is one of the commonest endocrine metabolic disorders in women of reproductive years. It is very disappointing that we have still not been able to know the exact cause, and hence, we cannot completely cure this syndrome. With availability of effective drugs and lifestyle modification, it can only be controlled and symptoms can be reduced. There are some well-defined factors which lead to PCOS phenotype. A concept of secondary PCOS is being described recently. This condition, even though rare, is completely curable, as majority of these factors are treatable. Hence, it is advisable to actively look for these conditions and offer treatment in time. This editorial gives an account of various causes of secondary PCOS, gives broader view of PCOS phenotypes and aims for an insight into pathophysiological aspects of PCOS. The clinical categorization by HA-PODS nomenclature of both primary and secondary PCOS can minimize diagnostic and therapeutic pitfalls and will serve as a checklist to ensure the appropriate investigation is ordered and specific treatment is initiated as per diagnostic code. This will achieve uniformity in therapies offered and also enable better comparison of data and a smooth conduct of research which is much needed in this field. [ABSTRACT FROM AUTHOR]