A review of hyperprolactinaemia and severe mental illness: Are there implications for clinical biochemistry?

Abstract

Hyperprolactinaemia is a common adverse event reported in association with treatments used in schizophrenia and bipolar disorder. Recent data are suggestive that hyperprolactinaemia may have a range of significant short-and long-term clinical consequences. The objective of this review is to examine the causes, frequency and clinical consequences of hyperprolactinaemia in the severely mentally ill (SMI) with a focus on patients taking antipsychotic medications. A Medline search was carried out to identify relevant publications. Reference lists from previous review articles were also examined to search for additional data. Hyperprolactinaemia may be one of the most common adverse events associated with some antipsychotic medications. Precise rates with individual drugs had however until recently been poorly categorized. The relationship between hyperprolactinaemia and adverse outcomes in the SMI population appears similar to that in the general population. Adverse outcomes (such as sexual dysfunction) can occur acutely and in the longer term (bone fractures and possibly breast cancer), but the precise link between degree and length of hyperprolactinaemia and adverse outcome remains to be established. In conclusion, hyperprolactinaemia is a common treatment-emergent adverse event of some antipsychotic medications and may have clinical consequences. Physicians must balance the benefits and risks of treatment when determining appropriate therapy for individual patients.

Correlation between Levels of Serum Prolactin and Total Sialic Acids Concentrations in Fertile and Infertile Women

“…PRL within gonadotroph cells are controlled by dopamine, the main hypothalamic inhibitory regulator of PRL release in vivo, this specific actions of PRL within the gonadotroph and the cell signaling interactions that ultimately underlie hyperprolactinemia-induced infertility (27); hyperprolactinemia can occur in physiological and pathological conditions (28) such as psychotic stress, severe mental illness or other causes, and the reproductive dysfunction affecting about one third of infertile women (29).…”

Hyperprolactinaemia caused by antipsychotic drugs: a new application for prolactin assays

“…Given these recommendations and given the fact that antipsychotics are often utilized outside their licensed applications, 1 the potential workload for the laboratory from patients treated with antipsychotic drugs is considerable. This is illustrated in a recent report that indicated that 25% of prolactin requests came from psychiatry.…”

“…(1) Manufacturers should review their reference intervals for serum prolactin and consider carrying out further studies in line with recommended practice 8 to improve their accuracy; (2) Laboratories should review their quoted reference intervals and consider whether these are appropriate for patients undergoing treatment with antipsychotics; (3) It seems probable that inaccurate reference intervals for serum prolactin will have affected the data reviewed by Bushe et al 1 and the estimates of the prevalence of hyperprolactinaemia in patients treated with antipsychotics and estimates of the prevalence by antipsychotic. Once reliable reference intervals are established, these data should be reviewed.…”

“…The review by Bushe et al 1 in this issue of the Annals draws attention to the detection and investigation of hyperprolactinaemia in patients treated with antipsychotic drugs. An editorial 2 in the British Medical Journal in 2002 indicated that it had been known for 25 y that antipsychotic drugs could cause symptomatic hyperprolactinaemia, but this had attracted little clinical and scientific interest.…”

Prolactin and Schizophrenia, an Evolving Relationship

“…Prolactin is a polypeptide hormone originally discovered from the crop glands of pigeons in 1933 (Riddle et al, 1933; Bushe and Pendlebury, 2010), however there was some scepticism that prolactin even existed in humans until the 1970s as human prolactin was considered identical to growth hormone (GH). During the 1970s, the development of radioimmunoassay techniques allowed the isolation of prolactin and its subsequent measurement (Kohen and Wildgust, 2008).…”