High levels of serum prolactin associated with antipsychotic use: Should we be concerned? About two cases

Emna Mraihi; Imen Rojbi; Sabrine Mekni; Sawsen Essayeh; Rihab Laamouri; Meriem Werfelli; Karima Khiari; Nacef Ibtissem Ben

doi:10.1530/endoabs.99.EP1311

EP1311

Prev Next

Section Contents Cite

Endocrine Abstracts (2024) 99 EP1311 | DOI: 10.1530/endoabs.99.EP1311

ECE2024 Eposter Presentations Late Breaking (127 abstracts)

High levels of serum prolactin associated with antipsychotic use: Should we be concerned? About two cases

Emna Mraihi ¹ , Imen Rojbi ^1,2 , Sabrine Mekni ^1,2 , Sawsen Essayeh ^1,2 , Rihab Laamouri ¹ , Meriem Werfelli ¹ , Karima Khiari ¹ & Ibtissem Ben Nacef ^1,2

Err

Author affiliations

¹Charles Nicolle Hospital, Tunis, Tunisia; ²Laboratory of renal pathology (LR00SP01), Tunis, Tunisia

Introduction: Antipsychotic-induced hyperprolactinemia is a prevalent hindering condition that is often overlooked. It is responsible for several significant consequences that alter the patients’ therapeutic compliance and quality of life. It can be a debilitating condition that warrants routine assessment and careful management through well-structured protocols.

Case details: We report the case of two patients treated with antipsychotics: -The first one was a 25-year-old female with a personal history of chronic psychosis grafted onto mental disability treated with risperidone 2 mg per day. She presented with hyperprolactinemia (serum prolactin = 277 ng/ml) associated with secondary amenorrhea and galactorrhea.-The second female patient was 31-year-old with a personal history of schizophrenia stabilized on both clozapine 100 mg per day and amisulpride 400 mg per day presented with hyperprolactinemia (serum prolactin=168 ng/ml) associated as well with secondary amenorrhea. Neither patient exhibited signs of tumor syndrome. We ruled out, first, any active pregnancy. Then we measured serum thyroid stimulating hormone that came back in the normal range excluding, thus, primary hypothyroidism. Both patients had no renal insufficiency Pituitary MRIs were lastly conducted to rule out prolactinomas or tumors causing the ‘Stalk effect’. A bone density test was performed to evaluate the long-term effect of hyperprolactinemia on the bone mass and showed no signs of osteopenia/osteoporosis. Since drug switch or discontinuation, as well as dose reduction, were not possible we aimed for hormone replacement therapy with estrogen.

Conclusion: Antipsychotic-induced hyperprolactinemia is a widespread endocrine disorder that can typically range from 25 to 100 ng/ml. Levels above 100 ng/ml can be observed and need further evaluation to rule out lactotroph tumors. Its approaches are controversial and numerous clinical trials are still being conducted.