Chanson Philippe
Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France.
Best Pract Res Clin Endocrinol Metab. 2022 Dec;36(6):101711. doi: 10.1016/j.beem.2022.101711. Epub 2022 Oct 12.
While the prevalence of hyperprolactinemia under antidepressants is very low, its prevalence under antipsychotics, particularly of the first generation, is high. Antipsychotics act by blocking dopamine activity at the level of the dopamine type 2 receptor (D2R). When prolactin levels exceed 80-100 ng/ml, a pituitary adenoma must be ruled out by MRI. Treatment of hyperprolactinemia is necessary only in cases with clinical symptoms of hypogonadism. Three treatment options are possible: switch to a less hyperprolactinemic antipsychotic, sex steroid supplementation or dopamine agonist (which normalizes prolactin levels in only half of cases). Fortunately, psychotic exacerbation due to the opposing effects of antipsychotics and dopamine agonists on the D2R seems very rare. When a patient presents with a macroprolactinoma, particularly with optic chiasm compression, surgery or dopamine agonists may be proposed. The agonists are effective in reducing tumor mass and improving visual defects in the majority of patients but rarely normalize prolactin levels.
虽然抗抑郁药导致高催乳素血症的发生率很低，但抗精神病药，尤其是第一代抗精神病药导致的高催乳素血症发生率很高。抗精神病药通过阻断2型多巴胺受体（D2R）水平的多巴胺活性发挥作用。当催乳素水平超过80 - 100 ng/ml时，必须通过磁共振成像（MRI）排除垂体腺瘤。仅在出现性腺功能减退临床症状的情况下才需要治疗高催乳素血症。有三种治疗选择：换用催乳素血症较轻的抗精神病药、补充性类固醇或使用多巴胺激动剂（仅半数病例可使催乳素水平恢复正常）。幸运的是，抗精神病药和多巴胺激动剂对D2R的相反作用导致精神病恶化的情况似乎非常罕见。当患者出现大催乳素瘤，尤其是伴有视交叉受压时，可考虑手术或使用多巴胺激动剂。激动剂在大多数患者中可有效减小肿瘤体积并改善视觉缺陷，但很少能使催乳素水平恢复正常。
