Emotional Aspects of Hyperprolactinemia

Abstract

Patients with hyperprolactinemia often present with emotional difficulties. These occasionally persist even after successful treatment. Insight into the roots of their diseased state makes a difference in the handling of all cases, but becomes crucial in the not-so-rare situations in which the normalization of hormonal levels is not followed by a feeling of cure. This chapter attempts to provide details, discuss and situate in context the following blocks of pertinent information: (1) prolactin acts upon the central nervous system and variations in its concentrations do affect mood, emotions and behavior; (2) most actions of prolactin are directed to metabolical and behavioral adaptation to pregnancy and the care of the young; (3) even in the absence of pregnancy prolactin secretion responds to environmental stimuli under specific conditions. Whether adaptive, as in the case of surrogate maternity, or pathological, as in the case of pseudopregnancy, prolactin responds to a perceived need to take care of a child; (4) the facts that the clinical onset of prolactinomas often follows life-events and that these tumors occur preferentially in women brought up under specific conditions suggest the possibility that psychological factors may predispose to prolactinomas; (5) dealing with individual cases requires the perception that the relations between prolactin, emotions and feelings are circular, i.e., prolactin affects the brain and mood but, on the other hand, personality traits and environmental factors may stimulate the secretion of prolactin and may play a role in the genesis of the disease.

Prolactin, Thyroid Stimulating Hormone and Thyroid Hormones (Ft3, Ft4) Concentrations in Female Patients with Inferility: An Observational Study

“…Another retrospective study found no correlation between the two [27]. Hyperprolactinaemia may be associated with subtle psychological symptoms such as anxiety, depression and hostility that occasionally persist even after successful treatment of elevated PRL [28,29].…”

How should the psychological well‐being of zoo elephants be objectively investigated?

“…In adult females, this can be manifest as impaired cycling/reduced estrous periods, low libido, premature reproductive senescence, reduced conception rates, increased pre-term fetal losses, prolonged parturitions, smaller birth weights, asymmetrical infant development, increased offspring stress responsiveness, poor maternal care (or infanticide), and/or increased infant mortality. Many of these effects stem directly from HPA axis overactivation, but additional causal factors include stress-induced prolactin elevation [Sobrinho, 1998[Sobrinho, , 2003 and, more speculatively, luteolytic stress-activated protein kinases [as activated by mitogens: Yadav et al, 2001]. Oxytocin, too, is a crucial reproductive and maternal hormone, especially during parturition and in the early stages of maternal care, whose release can be inhibited by stress [see e.g., Leng et al, 1987;Pedersen and Boccia, 2002;Kiecolt-Glaser et al, 2002].…”

Estados hiperprolactinêmicos: inter-relações com o psiquismo

“…Variações nas concentrações de prolactina no sistema nervoso central poderiam afetar o humor, as emoções e o bem-estar. Por outro lado, traços da personalidade e fatores externos ambientais podem estimular a secreção de prolactina e ter papel na gênese da doença (Sobrinho, 1998). Dentre o conhecimento de reações psicossomáticas e hiperprolactinemia, um exemplo típico é a pseudociese, que pode ser uma ativação extratemporal do sistema neuroendócrino (Sobrinho, 1993).…”

“…Assies et al (1992), ao avaliarem 14 pacientes hiperprolactinêmicas quanto a aspectos psicossociais, verificaram maior freqüência de separação dos pais na infância quando comparados a 14 mulheres controles. O estresse poderia ser o gatilho de alterações neuroendó-crinas envolvendo dopamina e/ou serotonina, que afetam a liberação de prolactina (Sobrinho, 1998;Freeman et al, 2000). Sonino et al (2004), estudando 52 pacientes com hiperprolactinemia, observaram que estes relatavam significativamente mais eventos pessoais estressantes que os indivíduos controles.…”

“…Para Sobrinho (1998), a simples informação a um paciente da presença de um tumor hipofisário poderia gerar ansiedade ou depressão, dependendo da personalidade do paciente e do contexto cultural. Por outro lado, observa-se ansiedade também em pacientes sem evidências de adenomas (Keller et al, 1985;Reavley et al, 1997).…”