Efficacy and safety in the treatment of hyperprolactinemia: A systematic review and network meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: Hyperprolactinemia is a neuroendocrine disease that is responsible for a quarter of cases of secondary amenorrhea, which can lead to infertility in women. Dopaminergic agonists (bromocriptine, cabergoline, quinagolide) can be used in the treatment. However, there is a lack of secondary studies that compare their efficacy and safety, especially through a network meta-analysis. Thus, to contribute to the decision-making, a systematic review and network meta-analyses (NMA) were performed to evaluate the efficacy and safety of dopaminergic agonists in the treatment of hyperprolactinemia. METHODS: Randomized clinical trials (RCT) were retrieved through PubMed, Web of Science and Scopus databases. The efficacy and safety of the drugs were compared, considering the following outcomes: prolactin (PRL) levels, number of patients with galactorrhoea, menstrual irregularities and adverse drug reactions. NMA was built for each outcome. Results were reported as odds ratios (OR) with 95% credibility intervals. Ranking probabilities were calculated by surface under the cumulative ranking analysis (SUCRA) and Stochastic multicriteria acceptability analysis (SMAA). RESULTS AND DISCUSSION: Seventeen RCTs were included in the systematic review and fifteen in the meta-analyses. The drugs had similar efficacy, considering the PRL levels. The SUCRA analysis showed that quinagolide (0.075 and 0.05 mg/day) was superior for reducing irregular menstruation, whereas bromocriptine was the best (97%) for galactorrhoea. Cabergoline proved to be the safest drug, except for abdominal pain at a dose of 1 mg/week. The SMAA demonstrated similar results to SUCRA. WHAT IS NEW AND CONCLUSION: This is the first network meta-analysis that evaluated the efficacy and safety of dopaminergic agonists in the treatment of hyperprolactinemia. The results of this review revealed that these drugs have similar efficacy, but cabergoline has a better safety profile.

[Irregular secretion of prolactin in infertile women with normoprolactinemic galactorrhea]. / Secreción irregular de prolactina en mujeres infértiles con galactorrea normoprolactinémica.

BACKGROUND: Abnormal frequency and pulse amplitud of prolactin secretion in micro and macroprolactinomas has been atributed to a dysfunctional tumoral lactotrope. Previous evidence suggests that non tumoral hyperprolactinemia is caused by a hypothalamic dysfunction. The regularity of prolactin secretion has not been studied with cuantitative methods in patients with normoprolactinemic galactorrhea (NPG) which could be considered an entity that precedes non tumoral and tumoral hyperprolactinemia. OBJECTIVE: To analyze the 24-hour prolactin secretion pattern and its secretion regularity in a group of infertile women with normoprolactinemic galatorea. PATIENTS AND METHODS: A transversal-comparative study was carried out in 6 infertile women with normoprolactinemic galactorrhea and 4 healthy women as controls. The 24 hour prolactin profile, the ratio night time mean concentration/daytime mean concentrattion (NM/DM ratio) and apparent entropy (Ap En, Ap En ratio) were compared in the two groups. RESULTS: Blunting of the nyctohemeral rythm and nocturn hyperprolactinaemia occurred in patients with normoprolactinemic galactorrhea (NPG). NM/DM ratio was lower in patients with NPG than in controls (1.28 +/- 0.25 vs. 1.75 +/- 0.05; p= 0.01). Higher irregularity of prolactin secretion was found in patients with NPG (ApEn: 0.853 +/- 0.158 vs 0.608 +/- 0.171, p=0.04; Ap En ratio: 0.839 +/- 0.11 vs 0.661 +/- 0.14; p=0.04). CONCLUSIONS: The irregularity of prolactin secretion in patients with NPG is not dependant on the presence of a pituitary tumour which suggests that a hypothalamic dysfunction underlies this condition. An irregular secretion and a higher daily mass production of prolactin in patients with NPG could explain both galactorrhea and infertility.

Low serum prolactin levels in native women at high altitude.

OBJECTIVES: To determine the serum prolactin levels in women at sea level and at high altitude, and the prevalence of hyperprolactinemia in both places. METHODS: The study included 303 normal women and 112 women with any reproductive dysfunction (menstrual abnormalities, galactorrhea or dysmenorrhea). From these, 228 were living in Lima at 150 m above sea level and 187 were living in Cerro de Pasco at 4340 m. Normal women included nonpregnant and pregnant women. Menstrual abnormalities included amenorrhea, oligomenorrhea and polymenorrhea. RESULTS: Serum prolactin levels were significantly lower in nonpregnant and pregnant women living at high altitude than at sea level. Prevalence of hyperprolactinemia, galactorrhea and menstrual abnormalities were significantly lower at high altitude than at sea level. CONCLUSIONS: It is concluded that menstrual abnormalities associated with hyperprolactinemia is a rare condition at high altitude. The low serum prolactin level observed at high altitude could be due to a high dopaminergic activity.

Trastornos menstruales en estudiantes universitarias: II Menarquia y dismenorrea / Menstrual upsetting in the female universitary student: II Menarch and Dysmenorrhea

Se analizaron 765 (20,20%) del total de la población femenina de 3.787 estudiantes durante el período comprendido comprendido entre enero y marzo de 1988. Encontramos que la menarquía ocurrió a la edad de 11,97 ñ 1,5 años y en el 98,5% fue de aparición espontánea. El 70% de las estudiantes encuestadas presentaban dismenorrea; el 84% de ellas tenía 25 o menos años. En el 88% de las encuestadas, la dismenorrea les duraba los dos primeros días del período menstrual

Transtornos menstruales en estudiantes universitarias. Amenorrea y oligomenorrea / Menstruation disorders in students university. Amenorrhea and oligomenorrhea

Durante el período comprendido entre enero y marzo de 1988, se encuestaron 801 estudiantes de la Facultad de Medicina de la Universidad del Zulia siguiendo el método del azar. se analizaron 765 (20,20%) del total de la población femenina de 3.787 estudiantes. Se encontró que la frecuencia de la amenorrea fue de 8,35% y de oligimenorrea de 22,41%. La separación del núcleo familiar fue el factor más importante e influyente en la producción de estos trastornos, así como también otros factores relacionados a la vida de la universitaria, como exámenes, estudios, etcetera