Hyperprolactinemia drug-induced

Sex differences in hormone concentrations have been investigated in 47 patients (21 men and 26 women) with schizophrenia or related psychoses who were using different neuroleptic drugs (757). The median daily dose and the median body weight-adjusted daily dose were twice as high in men as in women. However, neuroleptic drug-induced hyperprolactinemia was more frequent and occurred at a lower daily dose in women. The growth hormone concentration was normal in all patients. 

The relation between antipsychotic drug-induced hyperprolactinemia and hypoestrogenism has been studied in 75 women with schizophrenia (762). Serum estradiol concentrations were generally reduced during the entire menstrual cycle compared with reference values. There was hypoestrogenism, defined as serum estradiol concentrations below 30 pg/ml in the follicular phase and below 100 pg/ml in the periovulatory phase, in about 60%. 

Two women with neuroleptic-drug induced hyperprolactinemia, menstrual dysfunction, and galactorrhea had improvement in these adverse effects during treatment with olanzapine (855). 

Prolactin-producing hypophyseal adenoma (prolactinoma) is the most common functional pituitary adenoma. Its prevalence peaks in women between 20 and 30 years of age. Hyperprolactinemia can be a cause of infertility and is associated with diminished gonadotropin secretion, secondary amenorrhea, and galactorrhea. The patient should first be examined for drug-induced hyperprolactinemia before any infertility work-up is initiated. For example, antidepressants, cimetidine, dopamine antagonists, reser-pine, sulpiride, verapamil, methyldopa, and estrogen therapy are known to interface with prolactin secretion. 

Aripiprazole for 8 weeks has been used in 24 patients with hyperprolactinemia induced by risperidone, amisulpride, or sulpiride [132 ]. Prolactin concentrations fell from 77 to 18 ng/ml in those taking risperidone, from 145 to 128 in those taking amisulpride, and from 71 to 43 ng/ml in those taking sulpiride. Aripiprazole had no significant effect on metabolic measures or scales of movement adverse reactions. Nevertheless, it should be remembered that antipsychotic drug combinations are not approved for any indication. 

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