title: [Antipsychotics and hyperpolactinaemia: pathophysiology, clinical relevance, diagnosis and therapy].
abstract: Hyperprolactinaemia is a frequent but often neglected side effect of typical, but also of many atypical antipsychotics such as amisulpiride, risperidone or ziprasidone. Besides galactorrhoea, potential consequences are suppression of the hypothalamic-pituitary-gonadal axis with hypogonadism, sexual dysfunction, infertility and in women also irregularities of the menstrual cycle and amenorrhoea. Potential long term consequences are mainly osteopenia and osteoporosis with an enhanced risk of fractures. Hyperprolactinaemia, if not clearly caused by a prolactin inducing antipsychotic, should always be thoroughly investigated. Ideally, prolactin should be measured before starting a patient on a new antipsychotic. Furthermore, before neuroleptic treatment is begun, and also in regular intervals after that, patients should be asked about potential clinical signs of hyperprolactinaemia. Hyperprolactinaemia which is clearly due to antipsychotics but without clinical symptoms only requires regular controls of bone mineral density. However, if clinical symptoms occur, switching to a prolactin sparing antipsychotic may be necessary. In these cases fertility is often regained and the women concerned have to be informed about the enhanced risk of pregnancy and counselled regarding contraception. If switching is not possible, estradiol has to be substituted in women. Also in men with hypogonadism hormonesubstitution (with testosterone) is usually indicated. Generally hyperprolactinaemia in psychiatric patients should be taken more seriously in the future.
authors: Psychiatrische Poliklinik, Universitätsspital Basel. ariecher@uhbs.ch
authors: Anita
authors: A
authors: Riecher-Rössler
authors: Christoph
authors: C
authors: Schmid
authors: Stefan
authors: S
authors: Bleuer
authors: Martin
authors: M
authors: Birkhäuser
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D003937:Diagnosis, Differential; D015914:Estrogen Replacement Therapy; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D007006:Hypogonadism / Q000139:chemically induced / Q000503:physiopathology; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D007246:Infertility / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011618:Psychotic Disorders / Q000188:drug therapy*; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced / Q000503:physiopathology; D013739:Testosterone / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D013739:Testosterone