title: Antipsychotic-induced hyperprolactinaemia.
abstract: OBJECTIVE
  Antipsychotic medications are a potential cause of hyperprolactinaemia and may be implicated in the development of pituitary adenomas. This review examines the effect of different antipsychotic medications on prolactin and sexual function, and provides practical guidelines for investigation and management of antipsychotic-induced hyperprolactinaemia.
  
  
  METHODS
  Literature review.
  
  
  CONCLUSIONS
  Antipsychotic-induced hyperprolactinaemia occurs overall in up to 70% of patients with schizophrenia, depending on the medications used. It is associated with significant levels of hypogonadism and sexual dysfunction, which in general relates to the degree of prolactin elevation. A consequence of the hypogonadism is clinically significant bone loss which may lead to osteoporosis and increased risk of minimal trauma fracture. Where the potentially offending drug cannot be safely withdrawn to document a normal prolactin, imaging with MRI should be undertaken to exclude a structural pituitary lesion. The management strategy of choice is switching to a prolactin-sparing antipsychotic. Sex steroid replacement can reverse many of the adverse effects including the hypogonadal symptoms and bone loss. Low dose dopamine agonist therapy should be used with caution as a third line treatment, since there have been cases of dopamine agonist-induced exacerbation of psychosis. There is a need for a randomised controlled trial of low dose dopamine agonist therapy versus sex steroid replacement to establish the relative safety and efficacy of each approach.
authors.affiliation: Department of Endocrinology and Diabetes, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia. winder@medstv.unimelb.edu.au
authors.forename: Warrick J
authors.initials: WJ
authors.lastname: Inder
authors.forename: David
authors.initials: D
authors.lastname: Castle
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use*; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy*; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D011388:Prolactin / Q000187:drug effects / Q000502:physiology; D012725:Sexual Behavior / Q000187:drug effects; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D014150:Antipsychotic Agents; D018491:Dopamine Agonists; D012739:Gonadal Steroid Hormones; D011388:Prolactin