[Galactorrhoea and the use of selective serotonin reuptake inhibitors]. / Galactorroe en het gebruik van selectieve serotonineheropnameremmers.

The subject of this case study is a female patient who was treated with a selective serotonin reuptake inhibitor (SSRI), citalopram, because of a depressive episode. She developed symptoms of galactorrhea; there was a time relationship between suspension of the treatment with citalopram and a reduction of the galactorrhea symptoms. The consulting internist assumed that the symptoms were due to hyperprolactinemia arising from under-supplementation of thyroid hormone and resultant hypothyroidism. Psychiatrists usually see galactorrhea in patients who are taking antipsychotics. However, few psychiatrists know that galactorrhea can also be caused by SSRIs. When a patient has symptoms of bilateral galactorrhea and has used an SSRI and when hyperprolactinemia has been found in laboratory tests it is probably advisable to stop the SSRI medication. The article mentions what additional research is needed.

Quantification of vitamin B6 vitamers in human cerebrospinal fluid by ultra performance liquid chromatography-tandem mass spectrometry.

Since vitamin B6 is essential for normal functioning of the central nervous system, there is growing need for sensitive analysis of B6 vitamers in cerebrospinal fluid (CSF). This manuscript describes the development and validation of a rapid, sensitive and accurate method for quantification of the vitamin B6 vitamers pyridoxal (PL), pyridoxamine (PM), pyridoxine (PN), pyridoxic acid (PA), pyridoxal 5'-phosphate (PLP), pyridoxamine 5'-phosphate (PMP) and pyridoxine 5'-phosphate (PNP) in human CSF. The method is based on ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) with a simple sample preparation procedure of protein precipitation using 50 g L(-1) trichloroacetic acid containing stable isotope labeled internal standards: PL-D(3) for PL and PM, PN-(13)C(4) for PN, PA-D(2) for PA and PLP-D(3) for the phosphorylated vitamers. B6 vitamers were separated (Acquity HSS-T3 UPLC column) with a buffer containing acetic acid, heptafluorobutyric acid and acetonitrile. Positive electrospray ionization was used to monitor transitions m/z 168.1→150.1 (PL), 169.1→134.1 (PM), 170.1→134.1 (PN), 184.1→148.1 (PA), 248.1→150.1 (PLP), 249.1→232.1 (PMP) and 250.1→134.1 (PNP). The method was validated at three concentration levels for each B6 vitamer in CSF. Recoveries of the internal standards were between 93% and 96%. Intra- and inter-assay variations were below 20%. Accuracy tests showed deviations from 3% (PN) to 39% (PMP). Limits of quantification were in the range of 0.03-5.37 nM. Poor results were obtained for quantification of PNP. The method was applied to CSF samples of 20 subjects and two patients on pyridoxine supplementation. Using minimal CSF volumes this method is suitable for implementation in a routine diagnostic setting.