title: Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia.
abstract: BACKGROUND
  Iatrogenic hyperprolactinaemia (IHPRL) has been more frequently related to some antipsychotic drugs that provoke an intense blockade of dopamine D2 receptors. There is a wide variation in clinical practice, and perhaps some more awareness between clinicians is needed. Due to the high frequency of chronic treatment in severe mental patients, careful attention is recommended on the physical risk. IHPRL symptoms could be underestimated without routine examination.
  
  
  METHODS
  An intense scientific literature search was performed in order to draw up a multidisciplinary consensus, including different specialists of psychiatry, endocrinology, oncology and internal medicine, and looking for a consensus about clinical risk and detection of IHPRL following evidence-based medicine criteria levels (EBM I- IV).
  
  
  RESULTS
  Short-term symptoms include amenorrhea, galactorrhoea, and sexual dysfunction with decrease of libido and erectile difficulties related to hypogonadism. Medium and long-term symptoms related to oestrogens are observed, including a decrease bone mass density, hypogonadism, early menopause, some types of cancer risk increase (breast and endometrial), cardiovascular risk increase, immune system disorders, lipids, and cognitive dysfunction. Prolactin level, gonadal hormones and vitamin D should be checked in all patients receiving antipsychotics at baseline although early symptoms (amenorrhea-galactorrhoea) may not be observed due to the risk of underestimating other delayed symptoms that may appear in the medium term. Routine examination of sexual dysfunction is recommended due to possible poor patient tolerance and low compliance. Special care is required in children and adolescents, as well as patients with PRL levels >50ng/ml (moderate hyperprolactinaemia). A possible prolactinoma should be investigated in patients with PRL levels >150ng/ml, with special attention to patients with breast/endometrial cancer history. Densitometry should be prescribed for males >50 years old, amenorrhea>6 months, or early menopause to avoid fracture risk.
authors.affiliation: Área de Neurociencias, Instituto de Biomedicina de Salamanca (IBSAL), Universidad de Salamanca, Servicio de Psiquiatría, Hospital Universitario de Salamanca, España. Electronic address: amontejo@usal.es.
authors.forename: Ángel L
authors.initials: ÁL
authors.lastname: Montejo
authors.affiliation: Departamento de Psiquiatría Infanto-Juvenil, Hospital General Universitario Gregorio Marañón (IiSGM). Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España.
authors.forename: Celso
authors.initials: C
authors.lastname: Arango
authors.affiliation: Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardo
authors.affiliation: Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, CIBERSAM, Madrid, España.
authors.forename: José L
authors.initials: JL
authors.lastname: Carrasco
authors.affiliation: Departamento de Medicina y Psiquiatría, Universidad de Cantabria. Hospital Universitario Marqués de Valdecilla, IDIVAL, CIBERSAM, Santander, España.
authors.forename: Benedicto
authors.initials: B
authors.lastname: Crespo-Facorro
authors.affiliation: Servicio de Oncología Médica, Hospital Universitario de Salamanca, Universidad de Salamanca (IBSAL), España.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Cruz
authors.affiliation: Servicio Medicina Interna, Hospital Clínico Universitario, Universidad de Salamanca, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Del Pino
authors.affiliation: Unidad de Hospitalización Psiquiátrica, Hospital General y Universitario de Elche, España.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: García Escudero
authors.affiliation: Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España.
authors.forename: Clemente
authors.initials: C
authors.lastname: García Rizo
authors.affiliation: International Mood Disorders Research Centre, CIBERSAM, Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España.
authors.forename: Ana
authors.initials: A
authors.lastname: González-Pinto
authors.affiliation: FEA Psiquiatría, Red de Salud Mental de Guipúzcoa, San Sebastián, España.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Hernández
authors.affiliation: Instituto de Investigaciones Psiquiátricas, Fundación María Josefa Recio, Bilbao, España; Clínica Psiquiátrica Padre Menni, CIBERSAM, Pamplona, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martín Carrasco
authors.affiliation: UGC Salud Mental, Hospital Regional Universitario, Instituto de Biomedicina de Málaga, Málaga, España.
authors.forename: Fermin
authors.initials: F
authors.lastname: Mayoral Cleries
authors.affiliation: Servicio de Psiquiatría, Hospital Sierrallana, Torrelavega (Cantabria), España.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Mayoral van Son
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Universitario de Salamanca, España.
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Mories
authors.affiliation: Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pachiarotti
authors.affiliation: Instituto Internacional de Neurociencias Aplicadas, Barcelona, España.
authors.forename: Salvador
authors.initials: S
authors.lastname: Ros
authors.affiliation: Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsicóticos; Antipsychotic drugs; Consenso; Consensus; Disfunción sexual; Esquizofrenia; Hiperprolactinemia iatrogénica; Iatrogenic hyperprolactinaemia; Schizophrenia; Sexual dysfunction