Kratom, an Emerging Drug of Abuse, Raises Prolactin and Causes Secondary Hypogonadism: Case Report

Abstract

Background. Kratom is a drug derived from the leaves of the tree Mitragyna speciose, which is native to southern Thailand. The route of administration is oral. Kratom has become increasingly available in the United States. The active ingredients in the drug bind the opioid mu-receptor; therefore, kratom has similar physiological effects as mu-opioids. Elevated prolactin is a common medical condition frequently caused by a variety drugs, including opioids. Case Report. A 42-year-old man presented with poor energy and low libido. He had mildly elevated serum prolactin with hypogonadotropic hypogonadism as evidenced by low serum testosterone with luteinizing hormone and follicle-stimulating hormone in the normal range. At his initial visit, he reported no use of any recreational or therapeutic drug. Two months later when seen in follow-up, both the testosterone and prolactin levels had returned to normal. At that visit he reported frequent use of kratom, which he had discontinued a few days after the first visit. Discussion. Kratom is now widely available in health food stores and online and is considered an emerging drug of abuse. At present kratom is legal in the United States, but recently the Drug Enforcement Administration served noticed of its intention of making kratom a Schedule I drug. A number of adverse events or side effects have been reported, but this is the first report of hyperprolactinemia as the result of ingestion of kratom.

Characteristics of deaths associated with kratom use

“…These symptoms, together with anxiety, are reported by other researchers (Prozialeck et al, 2012; Singh et al, 2014; Swogger et al, 2015). Kratom appears capable of raising prolactin levels leading to secondary hypogonadism (LaBryer et al, 2018). Chronic use can also cause elevated levels of transaminases (Carter et al, 2016).…”

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

“…Overall, there were 41 cases on kratom-associated adverse events or toxicities (Table 1). Kratom-associated adverse events were as follows: kratom-associated withdrawal symptoms (KAWS) in adults [41][42][43][44][45][46][47][48][49][50][51][52], kratom-associated neonatal abstinence syndrome (KANAS) [48,[52][53][54][55][56], hypothyroidism [43], hypogonadism [57], kratom-induced hepatoxicity (KIH) [58][59][60][61][62][63][64][65], CNS effects causing seizure and coma or posterior reversible encephalopathy syndrome (PRES) [39,66,67], acute respiratory distress syndrome (ARDS) [68,69], overdose toxidrome [70,71], and fatalities [72][73][74][75][76][77][78][79][80]. There were six case series of aggregated patient's data [48,…”

“…Endocrine Effects: Hypothyroidism and Primary Hyperprolinemica [43,57] There were two cases that reported effects on the endocrine system. In LaBryer and colleagues' case report, kratom administration was associated with elevated prolactin and reduced testosterone levels leading to hyperprolactinemia and hypogonadotropic hypogonadism without an alternative identifiable cause [57]. The clinical significance of this change was manifested by decreased energy and libido.…”

Pharmacology of Herbal Sexual Enhancers: A Review of Psychiatric and Neurological Adverse Effects

“…The possible stimulant and libido-enhancing effects of mitragynine may be due to the blockade of serotonergic 5-HT 2A receptors and the postsynaptic stimulation of α 2 adrenergic receptors (α 2 R) in the CNS [ 212 ]. Recently, LaBryer et al hypothesized that kratom may have restored testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin levels in a patient with hypogonadotropic hypogonadism [ 213 ]. Mitragynine also binds adenosine A 2A receptors, dopamine D 2 receptors, and serotonin receptors 5-HT 2C and 5-HT 7 , but the physiological significance of these interactions is unclear [ 214 ].…”