Hummer Martina, Huber Johannes
Department of Biological Psychiatry, Innsbruck University Clinics, Innsbruck, Austria.
Curr Med Res Opin. 2004;20(2):189-97. doi: 10.1185/030079903125002865.
Prolactin is a polypeptide hormone that exists as a number of isoforms and is involved in a multitude of physiological processes. Prolactin secretion is promoted by various physiological stimuli and pathological processes and is inhibited by the action of dopamine on the lactotroph cells of the hypothalamus. Hyperprolactinaemia, an elevation of prolactin levels above the norm, is a physiological occurrence and is not of concern (including sexual dysfunction and decreased bone mineral density). Treatment of hyperprolactinaemia is usually confined to the removal of the primary cause of the disease, but several dopamine agonists have been investigated. Hyperprolactinaemia is also a side-effect of the conventional, and some of the second-generation, antipsychotics used in the treatment of schizophrenia. These agents rely on their dopamine antagonistic properties to provide their antipsychotic effects. However, this also removes the brake on prolactin secretion, leading to hyperprolactinaemia. While antipsychotic use has been linked to certain hyperprolactinaemia-related side-effects (sexual dysfunction), its link to others (decreased bone mineral density) has proved more controversial. The association of symptoms with antipsychotic use is further complicated by the fact that patients with schizophrenia can suffer from some of these symptoms because of the disease itself. In managing antipsychotic-induced hyperprolactinaemia, the initial step is to exclude other causes of hyperprolactinaemia while monitoring the occurrence of adverse effects. The physician should also engage in close consultation with the patient with regard to the benefits of the antipsychotic medication and the impact of any adverse effects. A regular risk-benefit discussion will allow the clinician to achieve optimal outcomes in each case.
催乳素是一种多肽激素,以多种异构体形式存在,参与众多生理过程。催乳素的分泌受各种生理刺激和病理过程的促进,并受多巴胺对下丘脑催乳细胞的作用抑制。高催乳素血症是指催乳素水平高于正常范围,这是一种生理现象,无需担忧(包括性功能障碍和骨密度降低)。高催乳素血症的治疗通常限于消除疾病的主要病因,但已对几种多巴胺激动剂进行了研究。高催乳素血症也是用于治疗精神分裂症的传统抗精神病药物以及一些第二代抗精神病药物的副作用。这些药物依靠其多巴胺拮抗特性来发挥抗精神病作用。然而,这也消除了对催乳素分泌的抑制,导致高催乳素血症。虽然使用抗精神病药物与某些高催乳素血症相关的副作用(性功能障碍)有关,但其与其他副作用(骨密度降低)的联系更具争议性。由于精神分裂症患者本身可能因疾病而出现其中一些症状,因此抗精神病药物使用与症状之间的关联更加复杂。在处理抗精神病药物引起的高催乳素血症时,第一步是排除高催乳素血症的其他原因,同时监测不良反应的发生。医生还应就抗精神病药物的益处和任何不良反应的影响与患者进行密切协商。定期进行风险效益讨论将使临床医生在每种情况下都能取得最佳结果。