Hiperprolactinemia y disfunción sexual en el primer episodio psicótico tratado con risperidona / Hiperprolactinaemia and sexual disfunction in first psychotic episode treated with risperidone

Hyperprolactinemia and Sexual dysfunction are frequent, yet seldom studied, complications of the use of risperidone Objectives: To determine the prevalence and clinical correlates of sexual dysfunctions and hyperprolactinemia in a sample of young people with schizophrenia treated with risperidone. Methods: 40 outpatients (19 females; mean age: 27 years) with schizophrenia treated with risperidone, participated in the study Sexual dysfunction and quality of life were assessed with the Massachusetts General Hospital Sexual Functioning Questionnaire (MGH-SFQ) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), respectively All patients were evaluated with the Positive and Negative Syndrome Scale and the UKU side effect rating scale. Blood samples were analyzed for prolactine. Results: Hyperprolactinemia was found in 90 percent of patients, with levels significantly higher in women. Sexual dysfunctions occurred in 25 (62.5 percent) patients. Patients with and without sexual dysfunction, did not significantly differ in gender, age or years of treatment. Although no association was found with prolactinemia or the dose of risperidone, patients with sexual dysfunction reported more psychic and neurologic side effects, and had higher scores in the negative symptoms and general psychopatology subscales of the PANSS and lower scores in the physical health and mood items of the Q-LES-Q. Conclusions: Results confirm the high prevalence of hyperprolactinemia and sexual dysfunctions in people with schizophrenia. Further study is warranted in order to clarify the association between sexual dysfunction and risperidone treatment in clinical practice and its impact in the quality of life of the patients.

La hiperprolactinemia y las disfunciones sexuales son complicaciones frecuentes, pero poco estudiadas del tratamiento con risperidona. Objetivos: Determinar la prevalencia de hiperprolactinemia y disfunciones sexuales en un grupo de personas jóvenes con esquizofrenia, tratadas con risperidona. Métodos: Un total de 40 pacientes (19 mujeres, edad promedio: 27 años) completaron el Cuestionario de Funcionamiento Sexual del Hospital General de Massachussets y el Cuestionario sobre Calidad de Vida: Satisfacción y Placer. Todos los pacientes fueron evaluados con las escalas PANSS y UKU y se determinó su nivel plasmático de prolactina. Resultados: El 90 por ciento de los pacientes presenta hiperprolactinemia, con valores significativamente más altos para las mujeres. El 62,5 por ciento de los pacientes, informó padecer alguna disfunción sexual, sin diferencias con la contraparte no afectada, en cuanto a género, edad ni tiempo de tratamiento. Aunque no se encontró relación con la prolactinemia, ni con la dosis de risperidona, quienes reportaron alguna disfunción sexual obtuvieron mayores puntajes de efectos adversos psíquicos y neurológicos en la escala UKU. Las disfunciones sexuales se asociaron con los síntomas negativos y generales de la PANSS y con menores puntajes en las subescalas de salud física y ánimo del Cuestionario sobre Calidad de Vida: Satisfacción y Placer. Conclusiones: Los resultados confirman la elevada frecuencia de disfunciones sexuales e hiperprolactinemia en las personas enfermas de esquizofrenia. Nuevos estudios se requieren para clarificar, en la práctica clínica habitual, la asociación entre disfunción sexual y el empleo de la risperidona, y su impacto en la calidad de vida de los pacientes.

Prevalência da macroprolactinemia entre 115 pacientes com hiperprolactinemia / Prevalence of macroprolactinemia among 115 patients with hyperprolactinemia

Macroprolactinemia caracteriza-se pelo predomínio no soro de uma prolactina (PRL) de alto peso molecular e baixa atividade biológica que não requer tratamento. A prevalência de macroprolactinemia foi avaliada em 115 pacientes consecutivos com hiperprolactinemia. Entre eles, 19 (16,5 por cento) tinham exclusivamente macroprolactinemia, 4 (3,5 por cento) síndrome dos ovários policísticos, 7 (6,1 por cento) acromegalia, 8 (6,9 por cento) hiperprolactinemia idiopática, 10 (8,7 por cento) hipotiroidismo primário, 14 (12,2 por cento) adenomas clinicamente não-funcionantes, 20 (17,4 por cento) hiperprolactinemia farmacológica e 33 (28,7 por cento) prolactinomas. O diagnóstico de macroprolactinemia foi estabelecido pela obtenção de uma recuperação da PRL < 30 por cento após tratamento do soro com polietilenoglicol. Dentre os 19 pacientes com macroprolactinemia isolada, 16 (84,2 por cento) eram mulheres e 12 (63,2 por cento) eram assintomáticos, enquanto 4 (21 por cento) tinham oligomenorréia e 3 (15,8 por cento), galactorréia. Em contraste, apenas 11,5 por cento dos indivíduos com outras causas de hiperprolactinemia eram assintomáticos (p< 0,001). Os níveis de PRL nos casos de macroprolactinemia variaram de 45,1 a 404 ng/mL (média de 113,3 ± 94,5), mas em 15 (78,9 por cento) foram < 100 ng/mL. Nossos achados demonstram que macroprolactinemia é uma condição freqüente e, assim, sugerimos que seja rotineiramente pesquisada em pacientes com hiperprolactinemia.

Macroprolactinemia is characterized by the predominance in the serum of macroprolactin, a prolactin (PRL) with high molecular mass and low biological activity that does not need treatment. The prevalence of macroprolactinemia was evaluated in 115 consecutive patients with hyperprolactinemia. Among them, 19 (16.5 percent) had solely macroprolactinemia, 4 (3.5 percent) polycystic ovary syndrome, 7 (6.1 percent) acromegaly, 8 (6.9 percent) idiopathic hyperprolactinemia, 10 (8.6 percent) primary hypothyroidism, 14 (12.2 percent) clinically non-functioning pituitary adenomas, 20 (17.4 percent) drug-induced hyperprolactinemia and 33 (28.7 percent) prolactinomas. The diagnosis of macroprolactinemia was established by the demonstration of a PRL recovery < 30 percent after treatment of sera with polyethylene glycol. Among the 19 patients with isolated macroprolactinemia, 16 (84.2 percent) were female and 12 (63.2 percent) were asymptomatic, while 4 (21 percent) presented with oligomenorrhea and 3 (15.8 percent) with galactorrhea. In contrast, only 11.5 percent of individuals with other causes of hyperprolactinemia were asymptomatic (p< 0.001). Prolactin levels in cases of macroprolactin ranged from 45.1 to 404 ng/mL (mean 113.3 ± 94.5) but in 15 (78.9 percent) were < 100 ng/mL. Our findings demonstrate that macroprolactinemia is a common condition and, therefore, we suggest that it should be routinely screened in patients with hyperprolactinemia.

Hyperprolactinemia and reproductive disorders--a profile from north east.

Serum prolactin was estimated in 90 women of various menstrual disorders and infertility. Hyperprolactinemia (PRL 25 ng/ml) was detected in twenty four cases. Out of these, nine had prolactinoma, four had hypothyroidism, three had drug induced HPRL and in eight, no cause could be ascertained. Five patients with prolactinoma became pregnant following bromocryptine treatment and delivered normal babies.