Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research

Grigg, Jasmin; Worsley, Roisin; Thew, Caroline; Gurvich, Caroline; Thomas, Natalie; Kulkarni, Jayashri

doi:10.1007/s00213-017-4730-6

Cited by 85 publications

(78 citation statements)

References 61 publications

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“…In patients on PRL-elevating drugs, PRL should be repeated after withdrawal of medications for 72 h, if possible [25,56]. However, this approach may not be safe if this treatment is offered for psychiatric indications [89]. If stopping the drug is not feasible, pituitary MRI is advised to rule out a sellar/parasellar tumour [25,56].…”

Section: Diagnostic Algorithmmentioning

confidence: 99%

“…In hyperprolactinaemia secondary to medication use, the preferred approach is to discontinue the offending drug [25,43]. However, this strategy may not be safe for patients with psychiatric disorders on antipsychotics [89]. Although antipsychotic-induced hyperprolactinaemia is common, there is no consensus on its management due to lack of high quality evidence [89].…”

Section: Pharmacologicalmentioning

confidence: 99%

“…However, this strategy may not be safe for patients with psychiatric disorders on antipsychotics [89]. Although antipsychotic-induced hyperprolactinaemia is common, there is no consensus on its management due to lack of high quality evidence [89]. Grigg et al [89] in a systematic review and critical analysis of published guidelines and literature on this topic proposed that, if possible, baseline PRL level should be drawn prior to initiating or changing antipsychotic therapy [89].…”

Section: Pharmacologicalmentioning

confidence: 99%

“…Although antipsychotic-induced hyperprolactinaemia is common, there is no consensus on its management due to lack of high quality evidence [89]. Grigg et al [89] in a systematic review and critical analysis of published guidelines and literature on this topic proposed that, if possible, baseline PRL level should be drawn prior to initiating or changing antipsychotic therapy [89]. Patients with asymptomatic hyperprolactinaemia due to antipsychotics should undergo periodic monitoring of PRL, as well as regular clinical assessments for relevant manifestations [56,89].…”

Section: Pharmacologicalmentioning

confidence: 99%

“…Grigg et al [89] in a systematic review and critical analysis of published guidelines and literature on this topic proposed that, if possible, baseline PRL level should be drawn prior to initiating or changing antipsychotic therapy [89]. Patients with asymptomatic hyperprolactinaemia due to antipsychotics should undergo periodic monitoring of PRL, as well as regular clinical assessments for relevant manifestations [56,89]. For those with symptomatic hyperprolactinaemia, a trial of stopping the antipsychotic medication is not recommended due to risk of exacerbation or relapse of psychiatric symptoms [89].…”

Section: Pharmacologicalmentioning

confidence: 99%

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Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through "stalk effect") are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.

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Section: Diagnostic Algorithmmentioning

confidence: 99%

Section: Pharmacologicalmentioning

confidence: 99%

Section: Pharmacologicalmentioning

confidence: 99%

Section: Pharmacologicalmentioning

confidence: 99%

Section: Pharmacologicalmentioning

confidence: 99%

See 3 more Smart Citations

Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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Characterization of Hip Fractures Among Adults With Schizophrenia in Ontario, Canada

et al. 2023

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ImportanceEvidence suggests that individuals with schizophrenia are at an increased risk of hip fractures; however, the sex-specific burden of hip fractures among adults with schizophrenia has not been quantified and compared with the general population.ObjectiveTo describe sociodemographic and clinical characteristics of patients with hip fracture and schizophrenia and to quantify their sex-specific annual hip fracture rates relative to those without schizophrenia.Design, Setting, and ParticipantsThis repeated population-based, cross-sectional study leveraged multiple individually linked health administrative databases for patients in Ontario, Canada. We included patients aged 40 to 105 years with hip fracture–related hospitalization between April 1, 2009, and March 31, 2019. Statistical analysis was performed between November 2021 and February 2023.ExposureSchizophrenia diagnosis, ascertained using a validated algorithm.Main Outcomes and MeasuresThe main outcome was sex-specific age-standardized annual hip fracture rate per 10 000 individuals and annual percent change in age-standardized rates. Rates were direct adjusted to the 2011 Ontario population, and joinpoint regression analysis was performed to evaluate annual percent change.ResultsWe identified 117 431 hip fracture records; of these, there were 109 908 index events. Among the 109 908 patients with hip fracture, 4251 had schizophrenia and 105 657 did not. Their median age was 83 years (IQR, 75-89 years), and 34 500 (31.4%) were men. Patients with hip fracture and schizophrenia were younger at the index event compared with those without schizophrenia. Men had a median age of 73 vs 81 years (IQR, 62-83 vs 71-87 years; standardized difference, 0.46), and women had a median age of 80 vs 84 years (IQR, 71-87 vs 77-89 years; standardized difference, 0.32). A higher proportion of patients with vs without schizophrenia had frailty (53.7% vs 34.2%; standardized difference, 0.40) and previous fragility fractures (23.5% vs 19.1%; standardized difference, 0.11). The overall age-standardized rate per 10 000 individuals with vs without schizophrenia was 37.5 (95% CI, 36.4 to 38.6) vs 16.0 (95% CI, 15.9 to 16.1). Age-standardized rates were 3-fold higher in men with vs without schizophrenia (31.0 [95% CI, 29.5 to 32.6] vs 10.1 [95% CI, 10.0 to 10.2]) and more than 2-fold higher in women with vs without schizophrenia (43.4 [95% CI, 41.9 to 44.9] vs 21.4 [95% CI, 21.3 to 21.6]). Overall, joinpoint regression analysis identified a steady annual decrease of 0.7% (95% CI, −1.1% to −0.3%) in age-standardized rates for both study groups.Conclusions and RelevanceThe findings of this cross-sectional study suggest that individuals with schizophrenia experience an earlier age of onset and considerably higher rate of hip fractures compared with the general population, with implications for targeted fracture prevention and optimization of clinical bone health management over the course of their psychiatric illness.

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The patient with hyperprolactinemia

Ayuk

2021

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Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research

Cited by 85 publications

References 61 publications

Hyperprolactinaemia

Hyperprolactinaemia

Characterization of Hip Fractures Among Adults With Schizophrenia in Ontario, Canada

The patient with hyperprolactinemia

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