Abstract
Purpose
To describe a series of cases with pharmacological hyperprolactinemia in primary care setting and the prolactin levels, clinical implications of different causes of pharmacological hyperprolactinemia.
Methods
A retrospective study of all patients with detected hyperprolactinemia in hormonal studies was performed between 2019 and 2020 in 20 Spanish primary care centers. Hyperprolactinemia is defined as a serum prolactin >19.4ng/ml in men and >26.5ng/ml in women. Four pharmacological causes of hyperprolactinemia were established: (i) oral contraceptives (OCPs) and other hormonal treatments; (ii) antipsychotics and antidepressants; (iii) other drugs (calcium antagonists, antiemetics, H2 antihistamines, opioids, and anabolic agents); and (iv) hyperprolactinemia due to several drugs.
Results
From a sample of 501 patients with elevated serum prolactin, 39.4% (n=162) had pharmacological hyperprolactinemia. The most common cause of pharmacological hyperprolactinemia in women was OCPs (n=61) while in men antipsychotics/antidepressants (n=21). In the cases of hyperprolactinemia due to antipsychotics/antidepressants, the prolactin levels were significantly higher in patients taking classical antipsychotics than in those taking second-generation antipsychotics (80.0±43.17 vs. 50.7±28.66 ng/dL, P=0.035). The antidepressant/antipsychotic group showed hyperprolactinemia-related symptoms more frequently than the group of other treatments (58.9% vs. 32%, P=0.001). The concomitant use of several drugs caused hyperprolactinemia-related symptoms more frequently than one drug alone (73% vs. 44%, P=0.031).
Conclusion
In this series of cases, drugs represented the 39.4% of the causes of hyperprolactinemia. The most common drugs were OCPs in women and antipsychotics/antidepressants in men. Antidepressants/antipsychotics were drugs that caused the greatest elevation of the prolactin levels and showed hyperprolactinemia-related symptoms more frequently.
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Data availability
The data that support the findings of this study are available on request from the corresponding author (AMGC). The data are not publicly available due to containing information that could compromise research participant privacy/consent.
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The support of all the participants who have agreed to participate in this study is greatly appreciated. It is also appreciated and recognized the help of IRYCIS for the Redcap database for data collection.
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The authors declare that all data were generated in-house and that no paper mill was used. All authors contributed to the study conception and design. The first draft of the manuscript was written by Ana M. Garcia Cano and Marta Araujo-Castro and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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All procedures performed by the participants of the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was evaluated and approved by the Ethical committee of Hospital Ramón y Cajal (approval date: 27/04/2021, ACTA 412).
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García Cano, A.M., Rosillo, M., Gómez Lozano, A. et al. Pharmacological hyperprolactinemia: a retrospective analysis of 501 hyperprolactinemia cases in primary care setting. Naunyn-Schmiedeberg's Arch Pharmacol 397, 3239–3246 (2024). https://doi.org/10.1007/s00210-023-02803-z
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DOI: https://doi.org/10.1007/s00210-023-02803-z