Table 2 - uploaded by Mehmet Gencer
Content may be subject to copyright.
Distribution of prolactin levels (ng/mL, mean±standard deviation) according to demographic and clinical features of MS and NMO patients
Source publication
Introduction:
Prolactin has been discussed as a factor likely to play a mediating role in multiple sclerosis (MS). Our aim was to investigate the possible association between prolactin production and clinical features of autoimmune demyelinating central nervous system disorders.
Methods:
Serum prolactin levels of 255 MS patients, 19 neuromyeliti...
Contexts in source publication
Context 1
... were obtained during attacks in 75 of 255 MS and 8 of 19 NMO patients. In both disease groups, prolactin levels in the attack sera were sig- nificantly higher than those in the remission sera (Table 2). Prolactin levels were above the normal range in 45/75 (60%) of MS attack sera and 6/9 (66.7%) of NMO attack sera. ...
Context 2
... of the polysymptomatic patients showed myelitis findings. While MS patients with myelitis attacks (n=12) displayed significantly higher prolactin levels than those without myelitis findings (n=63) (p<0.001 by Mann-Whitney U test) (Table 2) there were no significant prolactin level differences between patients with other types of attacks (not shown). Similarly, NMO patients with optic neuritis (n=2) and myelitis (n=8) attacks showed comparable prolactin levels (p=0.305 by Mann-Whitney U test) ( Table 2). ...
Context 3
... MS patients with myelitis attacks (n=12) displayed significantly higher prolactin levels than those without myelitis findings (n=63) (p<0.001 by Mann-Whitney U test) (Table 2) there were no significant prolactin level differences between patients with other types of attacks (not shown). Similarly, NMO patients with optic neuritis (n=2) and myelitis (n=8) attacks showed comparable prolactin levels (p=0.305 by Mann-Whitney U test) ( Table 2). ...
Context 4
... NMO and MS patients had higher prolactin levels than male pa- tients, as expected. However, no difference could be found between oli- goclonal band positive and negative MS and NMO patients and Aqp-4 antibody positive and negative NMO patients (Table 2). Similarly, no sig- nificant correlation was found between prolactin levels, age, number of attacks, disease duration, EDSS, and progression index scores in MS and NMO cohorts (R=0.041-0.136, ...
Citations
... Hypothalamic-pituitary-adrenal (HPA) axis dysfunction remains common in adults with MS (7,8). Studies have linked endocrine dysregulation (typically assessed through cortisol status) to male infertility (9-11), female infertility (12)(13)(14), symptomatic hyperprolactinemia (15)(16)(17), fatigue (18)(19)(20), hyperarousal states (21), depression (19,22), cognitive impairment (23)(24)(25), and most importantly, poorer clinical outcomes in adults with MS (6,(26)(27)(28)(29). The HPA-axis is linked to the production of sex hormones through negative feedback mechanisms ( Figure 1). ...
Background
Pediatric onset multiple sclerosis (POMS) commonly occurs at the time of various endocrine changes. Evaluation of the impact of endocrine status on disease severity in POMS has not been previously explored.
Objective
This study sought to evaluate if sex and stress hormones in children with POMS impact motor and non-motor diseases severity.
Methods
A single-center case control study was performed. Individuals with POMS were compared to individuals without neurologic disease. Each individual had three blood draws assessing stress and sex hormones between 07:00 and 09:00. Measures of fatigue (Epworth sleepiness scale), depression (PHQ-9), and quality of life (PedsQL) assessed at each visit.
Results
Forty individuals with POMS and 40 controls were enrolled. Individuals with POMS had lower free testosterone (p = 0.003), cortisol (p < 0.001), and ACTH (p < 0.001) and had higher progesterone (p = 0.025) levels than controls. Relapses and EDSS were not impacted by endocrine variables. The POMS cohort had a significantly higher Epworth score (p < 0.001), PHQ-9 score (p < 0.001), and lower PQL score (p < 0.001) than controls. Non-motor measures were not associated with endocrine status.
Conclusion
Free testosterone, cortisol, ACTH, and progesterone were abnormal in children with POMS although there was no association between endocrine status and markers of disease severity or non-motor symptoms of MS.
... MS is a demyelinating disease of the central nervous system characterized by abnormal immune regulation and activated immune cells in the brain and peripheral blood [59]. There were several mechanisms to explain the association between serum PRL levels and MS. ...
Introduction:
Prolactin (PRL) exerts inflammatory and anti-inflammatory properties and is also thought to play an important role in the pathogenesis of neurodegenerative diseases (NDs). However, serum PRL levels in patients with NDs were inconsistent in the research literature.
Objective:
We aimed to assess the serum PRL levels in patients with NDs.
Methods:
Electronic databases, including MEDLINE, Embase, Cochrane Library database, clinicaltrials.gov, Web of Science, and Google Scholar, and reference lists of articles were searched up to December 31, 2020. Pooled standard mean difference (SMD) with 95% confidence interval (CI) was calculated by fixed-effect or random-effect model analysis.
Results:
A total of 36 comparisons out of 29 studies (3 RCTs and 26 case controls) focusing on NDs (including Parkinson's disease, Alzheimer's disease, Huntington's disease [HD], multiple sclerosis [MS], and epilepsy) were reported. The meta-analysis showed that there was no statistically significant difference in serum PRL levels between patients with NDs and healthy controls (SMD = 0.40, 95% CI: -0.16 to 0.96, p = 0.16). Subgroup analysis showed that serum PRL levels in patients with HD and MS were higher than those of healthy controls. Furthermore, patients with NDs aged <45 years had higher serum PRL levels (SMD = 0.97, 95% CI: 0.16-1.78, p = 0.018) than healthy controls. High serum PRL levels were found in subgroups such as the microenzymatic method, Asia, and the Americas.
Conclusions:
Our meta-analysis showed serum PRL levels in patients with HD and MS were significantly higher than those in healthy controls. Serum PRL levels were associated with age, region, and detection method. Other larger sample studies using more uniform detection methods are necessary to confirm our results.
... PRL has been implicated in the pathogenesis of multiple sclerosis (MS) and other demyelinating disorders [149,153]. PRL is thought to have dual effect in the central nervous system; it stimulates regeneration of neurons, oligodendrocytes, and neural stem cells, and also promotes aberrant immune responses through stimulating B cell autoreactivity [149]. The latter mechanism possibly explains the correlation between hyperprolactinaemia and MS [140,149]. ...
... The latter mechanism possibly explains the correlation between hyperprolactinaemia and MS [140,149]. Patients with MS have higher PRL levels compared to controls, and this has also been shown in patients with neuromyelitis optica (NMO) [140,153]. Notably, PRL is higher in patients with MS or NMO during attacks compared with phases of remission [153] but it is still unclear whether hyperprolactinaemia is a primary cause or a secondary effect of the disease. ...
... Patients with MS have higher PRL levels compared to controls, and this has also been shown in patients with neuromyelitis optica (NMO) [140,153]. Notably, PRL is higher in patients with MS or NMO during attacks compared with phases of remission [153] but it is still unclear whether hyperprolactinaemia is a primary cause or a secondary effect of the disease. ...
Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through "stalk effect") are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.
... In a cohort study conducted by Turkuglu et al. in 2016, they assessed the serum prolactin levels of 255 MS patients, 19 neuromyelitis optica (NMO) patients, 15 clinically isolated syndrome (CIS) patients, and 240 healthy controls. They concluded that prolactin may have a role in the immunopathogenesis of MS, NMO and the conversion of CIS to MS [10]. This is not concordant with our study. ...
Background: The association between serum Prolactin (PRL) levels and disease activity in Multiple Sclerosis (MS) remains debated. Studies regarding the role of PRL in the immunology of MS (regardless of gender) have had conflicting results. Objective: This study aimed to compare the serum levels of PRL between the remission and relapse phases of MS and also between MS patients and healthy individuals. Methods: This study was conducted on 60 patients with a confirmed diagnosis of MS, 30 of which were in remission while the other 30 were in relapse, in addition to 30 sex-matched and age-matched healthy controls. Those with underlying conditions affecting serum PRL levels were excluded from the study. Serum PRL levels were measured in fasting blood samples. Duration of disease and the existence of enhancing/non-enhancing gadolinium plaques in brain MRIs were also recorded. Original Research Article Maghbooli et al.; AJORRIN, 2(1): 1-6, 2019; Article no.AJORRIN.49218 2 Results: Serum PRL levels did not significantly differ in the MS group based on disease phase (relapse or remission phases), gender, the existence of enhancing/non-enhancing plaques, disease duration and also between MS patients in relapse and remission phases with the control group (both men and women). Conclusions: There were no significant differences in serum PRL levels between the case and control groups (both genders). Also, no significant relationship between serum PRL levels and disease duration or the existence of active MRI lesions.
Background
In the last decade, evidence supports the hypothesis that the prolactin (PRL) hormone plays an important role in systemic lupus erythematosus (SLE) clinical expression and pathogenesis.
Objective
To evaluate the presence, clinical, and serological significance of elevated serum PRL in women with SLE.
Materials and Methods
A case–control study included 30 women with SLE; with mean age and disease duration were 33.15 ± 6.7 and 10.9 ± 1.9, respectively, and 30 age-matched apparently healthy subjects served as controls. All patients were subjected to clinical and serological evaluation. Disease activity was measured using the SLE Disease Activity Index. Serum PRL level was estimated for all the participants.
Results
Serum PRL levels were 36.2 ± 15.8 ng/ml and 8.9 ± 4.4 ng/ml in patients with SLE and controls, respectively. Malar rash, photosensitivity, and arthritis were associated with elevated serum PRL. Positive antinuclear antibodies ANA and low complements were associated with a high serum PRL level. In addition, 18 (85.7%) patients with high disease activity have hyperprolactinemia, while only 3 (14.3%) patients with high disease activity have a normal range of serum PRL levels.
Conclusion
SLE patients were associated with higher serum PRL levels than the control group. There was a significant relationship between serological status and hypocomplementemia with high serum PRL levels. In addition, there was a significant relationship between active disease and hyperprolactinemia.
Introduction:
Systemic prolactin levels have been found to increase in 19 patients diagnosed with neuromyelitis optica spectrum disorders (NMOSD). However, the relationship between plasma prolactin levels and clinical manifestations in NMOSD patients remains unclear.
Methods:
This cross-sectional study was conducted as part of a Registered Cohort Study of Inflammatory Demyelination Disease (NCT04386018). A total of 95 patients diagnosed with central nervous system demyelinating diseases and 43 healthy controls were recruited between May 2020 and February 2022 at the First Affiliated Hospital of Fujian Medical University. Plasma samples were collected from all participants and analyzed for prolactin levels using electrochemiluminescence immunoassay. The study aimed to investigate the correlation between plasma prolactin levels and clinical features in patients with central nervous system demyelinating diseases.
Results:
Plasma prolactin levels in NMOSD patients were significantly higher than those in multiple sclerosis/myelin oligodendrocyte glycoprotein antibody-associated diseases patients and controls (p<0.05, respectively), and were found to be correlated with disease activity, sensory abnormalities, thoracic spinal cord lesions, and MR lesion enhancement (p<0.05). A total of 16.28% of NMOSD patients exhibited macroprolactinemia. However, there was no correlation found between macroprolactin levels and disease activity (p>0.05).
Conclusion:
Prolactin may play a role in the pro-inflammatory regulation mechanism of NMOSD.
Rationale:
Neuromyelitis optica spectrum disorders (NMOSD) is a rare autoimmune disease predominantly involving optic nerves and spinal cord, and possible comorbidities including syndrome of inappropriate antidiuretic hormone secretion or urinary complication. We reported a young girl diagnosed with NMOSD presented with refractory hyponatremia, acute urine retention, and general weakness. Clinical symptoms improved gradually after receiving intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. NMOSD should be kept in mind in adolescence with acute urine retention, intermittent fever, and hyponatremia.
Patient concerns:
A 15-year-old girl admitted to our hospital due to no urination for 2 days.
Diagnosis:
Aquaporin-4 antibodies were detected showing positive both in serum and cerebrospinal fluid. Long transverse myelitis in cervical and thoracic spinal cord and optic neuritis was revealed in magnetic resonance imaging.
Interventions:
Intravenous immunoglobulin 2 g/kg was infused totally in 4 days, and methylprednisolone pulse therapy was subsequently followed in 5 days; followed by 5 courses of plasmapheresis a week later.
Outcomes:
Her muscle power, syndrome of inappropriate antidiuretic hormone secretion condition, and urinary function were all improved after immune-modulated treatment course; NMOSD relapsed twice within the first year after diagnosis, however no relapse of NMOSD in the subsequent 1 year.
Lessons:
To the best of our knowledge, this was the first childhood case of NMO accompanied by refractory hyponatremia in the reported literature. In childhood cases presenting with refractory hyponatremia and limb weakness, NMO or NMOSD should be considered possible diagnoses despite their rarity in pediatric cases.
Background
Reference intervals (RIs) play key roles in clinical diagnosis, treatment and prognosis. However, RIs for clinical testing tend to be confined to the general population, and RIs for pregnant women are not very comprehensive. In this study, we establish RIs for prolactin (PRL) in healthy pregnant and postpartum women in the Chinese population.
Methods
Healthy pregnant women (n=378) were divided into groups according to whether they were in the first, second or third trimester of pregnancy. Healthy postpartum women (n=493) were separated into four groups according to mode of delivery as follows: postvaginal (24 and 48 h) or postcesarean (24 and 48 h). Healthy, non-pregnant women (n=123) were enrolled as a control group. Serum PRL levels were measured by electrochemiluminescence immunoassay, and RIs were established for each group.
Results
The RIs for PRL were as follows: healthy non-pregnant women, 178.89–757.52 μIU/mL; first trimester, 621.20–3584.00 μIU/mL; second trimester, 1432.00–5349.68 μIU/mL; third trimester, 4087.33–9733.65 μIU/mL; 24 and 48 h postvaginal delivery (combined), 7865.36–10998.86 μIU/mL; and 24 and 48 h postcesarean delivery, 4556.41–7675.99 and 6578.45–9980.45 μIU/mL, respectively.
Conclusions
PRL RIs for pregnant women were established according to trimester, days postpartum and mode of delivery, thus providing a clinical reference for medical staff.
