Of hyperprolactinemia

Hyperprolactinemia commonly affects women of reproductive age more than men. Although this disorder occurs in less than 1% of the general population, the estimated prevalence in women with reproductive disorders (e.g., amenorrhea) is as high as 9% to 17%.43 Numerous etiologies of hyperprolactinemia are presented in Table 43-5.43,44 Any medications that block... 

Because hyperprolactinemia is often associated with hypogonadism, the goals for management of hyperprolactinemia are to restore the clinical consequences of hypogonadism and reduce its associated risk for osteoporosis44 (Table 43-7). 

FIGURE 43-4. Approach to management of hyperprolactinemia.44 MRI = magnetic resonance imaging. (Reprinted, with permission, from Serri O, Chik CL, Ezzat S. Diagnosis and management of hyperprolactinemia. Can Med Assoc J 2003 169(9) 575-581. 2003 by CMA Media, Inc.)... 

Once the prolactin level is normalized and clinical symptoms of hyperprolactinemia have resolved, monitor prolactin level every 6 to 12 months.43,44,46... 

Discontinuation of therapy in patients with macroprolactinomas usually leads to tumor regrowth and recurrence of hyperprolactinemia. This decision warrants careful consideration. 

Assess patient s clinical signs and symptoms of hyperprolactinemia. 

Review the available diagnostic data to determine severity and exclude other common causes of hyperprolactinemia. 

If the prolactin level remains normal for 2 years, reassess the need to continue treatment. Make sure that the patient is taking the lowest effective dose for management of hyperprolactinemia. 

In addition to the sexual side effects that can occur as a direct result of hyperprolactinemia, other sexual side effects may occur as well. These include ejaculatory difficulties, impotence, anorgastnia, priapism, and reduced libido (Hansen et ah, 1997 Arana, 2000). 

Dopamine Dopamine agonists used for treatment of hyperprolactinemia... 

Bromocriptine Activates dopamine D2 receptors Suppresses pituitary secretion of prolactin dopaminergic effects on CNS motor control and behavior Treatment of hyperprolactinemia and Parkinson s disease (see Chapter 28) Administered orally or vaginally Toxicity Gastrointestinal disturbances, orthostatic hypotension, headache, psychiatric disturbances, vasospasm and pulmonary infiltrates in high doses... 

The prevalence of hyperprolactinemia in patients with chronic schizophrenia taking long-term haloperidol has been studied in 60 patients in Korea (28 women illness mean duration, 15.5 years) (472). There was hyperprolactinemia, defined as a serum prolactin concentration over 20 ng/ml in men and 24 ng/ml in women, in 40 the prevalence of hyperprolactinemia in women (93%) was significantly higher than in men (47%). There was also a... 

Jung DU, Seo YS, Park JH, Jeong CY, Conley RR, Kelly DL, Shim JC. The prevalence of hyperprolactinemia after long-term haloperidol use in patients with chronic schizophrenia. J Clin Psychopharmacol 2005 25 613-5. 

Spitzer M, Sajjad R, Benjamin F. Pattern of development of hyperprolactinemia after initiation of haloperidol therapy. Obstet Gynecol 1998 91(5 Pt l) 693-5. 

Kinon BJ, Gilmore JA, Liu H, Halbreich UM. Prevalence of hyperprolactinemia in schizophrenic patients treated with conventional antipsychotic medications or risperidone. Psychoneuroendocrinology 2003 28 55-68. 

A vaginal suppository based on bromocriptine was employed for the therapy of hyperprolactinemia [32]. The rationale of the local vaginal delivery of bromocriptine lies in the noteworthy side effects consequent to oral therapy gastrointestinal disorders, extensive hepatic degradation, and hypotension. The pessary based on bromocriptine proved to be effective in lowering serum prolactin to normal levels after 20 days of local therapy the treatment was well tolerated by the majority of the patients and a minimal vaginal irritation was observed. 

Prolactin has been shown to increase LH receptor numbers in dwarf mice, seasonally repressed hamsters and hypophysectomized rats (see Ref. 6 for other references). In the hypophysectomized rats the combined effects of prolactin, growth hormone and LH were necessary to maintain the LH receptors [46]. The induction of hyperprolactinemia leads to increased LH receptors. Decreases in serum prolactin levels caused by treatment with compounds that inhibit the release of prolactin (dopamine analogues) decrease LH receptors (see Ref. 6 for other references). 

Selmanoff MK (1985) Rapid effects of hyperprolactinemia on basal prolactin secretion and dopamine turnover in the medial and lateral median eminence. Endocrinology 775 1943-1952. 

Bromocriptine Therapy of hyperprolactinemia Oral tablet and vaginal suppository Proved to be effective and safe, without the adverse effects of oral administration vaginal suppository obtained higher reduction in serum prolactin 330... 

In one study, the prevalence of hyperprolactinemia among women taking risperidone was 88% (n = 42) versus 48% (n = 105) in those taking conventional antipsychotic drugs 48% of these women of reproductive age taking risperidone had abnormal menstrual cycles (137). In the whole sample (147 women and 255 men) there were trends towards low concentrations of reproductive hormones associated with rises in prolactin patients taking concomitant medications known to increase prolactin had been excluded. Raised prolactin concentrations were also observed in 13 (9 women and 4 men) of 20 patients (13 women and 7 men mean age 36 years) (138). In premenopausal women there was a good correlation between prolactin concentrations and age, but there was no clear correlation between duration of treatment, dose, prolactin concentration, and prolactin-related adverse effects. 

The risk of prolactinoma in patients taking risperidone and other neuroleptic drugs, accompanied by hyperprolactinemia, amenorrhea, and galactorrhea has been discussed in the light of a case of hyperprolactinemia (160). 

Dopamine inhibits prolactin synthesis. Drugs that inhibit dopamine synthesis or activity (e.g. antihypertensives, antidepressants, estrogen, phenothiazines, opiates), are the most common cause of hyperprolactinemia. Prolactin-secreting pituitary tumors sometimes are treated with bromocriptine, a dopamine agonist. 

Rampello L, Nicoletti G. Sindrome da sospension della terapia con H2-antagonisti ipossibile ruolo della iperprolat-tinemia. [The H2-antagonist therapy withdrawal syndrome the possible role of hyperprolactinemia.) Medicina (Firenze) 1990 10(3) 294-6. 

Acutely methyidopa promotes the release of growth hormone and prolactin, but the long-term significance of this is unclear. However, there have been reports of hyperprolactinemia, leading to amenorrhea and galactorrhea (4). 

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