Prolactin Dysfunction Post ABI

Author/Year/
Country/Study Design/N

Methods

Outcomes

Kopczak et al. (2014)
Germany
Observational
N=509

Population: ABI; TBI Group (n=340): Mean Age=39yr; Gender: Male=257, Female=83; SAH Group (=169): Mean Age=49yr; Gender: Males=67, Females=102.
Intervention: PRL levels were assessed at median 7wk post injury. Hypoprolactinemia definition: PRL <2.1ng/mL (men); <2.8ng/mL (women). Hyperprolactinemia definition: PRL >17.7ng/mL (men); >29.2ng/mL (women).
Outcome Measure: Incidence of hypoprolactinemia or hyperprolactinemia. 

  1. PRL was elevated in 88 patients (17.3%), but only 14 of them were not receiving hyperprolactinemia-inducing drugs.
  2. Hypoprolactinemia was demonstrated in only 1 (0.2%) patient, who was admitted with SAH.

     

Olivecrona et al. (2013)
Sweden
Observational
N=45

Population: TBI; Mean Age=35.7yr; Gender: Male=30, Female=15; Median GCS=6.
Intervention: Changes in PRL levels were assessed from 1-4d post injury via serum samples. Clinical outcomes were obtained 3mo post injury. Normal range: PRL 86–324mIU/L (men) and 102–496mIU/L (women).
Outcome Measure: Levels of PRL, Glasgow Outcome Scale (GOS).

  1. On day 1, elevated levels of serum PRL were seen in 14 (48.3%) men and in 10(66.7%) women.
  2. Mean PRL levels increased from 1d to 4d in both men (357±25 versus 409±27 mIU/L; p<0.02) and women (571±38 versus 795±75 mIU/L; p<0.02).
  3. No significant differences were found in PRL levels between deceased and alive subjects or in the unfavourable (i.e., GOS 1–3) and favourable (i.e., GOS 4–5) groups at 3mo.
  4. PRL levels were not correlated to GCS and/or GOS scores.

     

Moreau et al. (2012)
France
Observational
N=55

Population: TBI; Mean Age=36.1yr; Gender: Male=46, Female=9; Mean Time Post Injury=79.2mo.
Intervention: PRL levels were assessed post injury via blood samples. Hyperprolactinemia definition: blood PRL >22ng/mL.
Outcome Measures: Incidence of hyperprolactinemia.

  1. 42 (76.4%) patients presented with at least 1 pituitary deficiency; hyperprolactinemia was noted in 4 (7.3%) patients.
  2. Given the relatively low proportions of patients with hyperprolactinemia, no further analysis was performed.

     

Kleindienst et al. (2009)
Germany
Observational
N=71

Population: TBI; Mean Age=53yr; Gender: Male=57, Female=14; Mean GCS=9.6.
Intervention: Blood samples of PRL were assessed on admission, days 3 and 7, and at follow-up (24–36mo post injury). Normal range: PRL <500µU/L.
Outcome Measure: Incidence of hyperprolactinemia. 

  1. 8 (15%) of 53 patients showed an elevated PRL level (>500µU/L) on admission, 5 (9%) of 55 on day 3, and 5 (13%) of 39 on day 7.
  2. 1 (5%) of 20 patients showed signs of hyperprolactinemia at follow-up.

     

Bondanelli et al. (2007)
Italy
Observational
N=72

Population: TBI; Mean Age=37.2yr; Gender: Male=56, Female=16; Mean Time Post Injury=240.5d; Injury Severity: Moderate=10, Severe=62.
Intervention: PRL level assessed at least once between 6 and 12mo post TBI to assess the frequency of hyperprolactinemia. Two baseline blood samples of PRL were obtained. Hyperprolactinemia definition: basal PRL >2–16µg/L (men); >4–24µg/L (women).
Outcome Measure: Incidence of hyperprolactinemia. 

 

  1. PRL was moderately elevated in 6 patients (27.7–56.9ng/mL).

Tanriverdi et al. (2007)
Spain
Observational
N=104

Population: TBI; Mean Age=38.8yr; Gender: Male=78, Female=26; Time Post Injury <24hr; Injury Severity: Mild=49, Moderate=24, Severe=31.
Intervention: Blood samples of PRL were assessed within 24hr of trauma. Hyperprolactinemia definition: PRL >2–18ng/mL (men); PRL >2.9–29ng/mL (pre-menopausal women); PRL >1.8–20ng/mL (post-menopausal women).
Outcome Measure: Incidence of hyperprolactinemia. 

  1. Data were available for 97 patients. Of these, 19 (18.3%) patients demonstrated hyperprolactinemia.
  2. GCS scores were negatively correlated with PRL levels (r=-0.26; p=0.01).
  3. There was no significant difference in mean PRL levels between the non-surviving (n=20) and surviving (n=84) patients with TBI.

     

Klose et al. (2007)
Denmark
Observational
N=104

Population: TBI; Median Age=41yr; Gender: Male=78, Female=26; Mean Time Post Injury=13mo; Injury Severity: Mild=44, Moderate=20, Severe=40.
Intervention: Lactotroph function assessed post injury via baseline measurements of PRL. Hyperprolactinemia definition: PRL >510 mIU/L.
Outcome Measures: Incidence of hyperprolactinemia.

  1. Hyperprolactinemia was observed in 2 patients (13%) with pituitary insufficiencies and in 8 patients (9%) with normal pituitary functions (p=0.7).

Schneider et al. (2006)
Germany
Observational
Ninitial=78 
Nfinal=70

Population: TBI; Mean Age=36yr; Gender: Male=52, Female=26; Mean GCS=7.4.
Intervention: PRL levels were assessed 3mo±2wk (T1) and 12mo±4wk (T2) post injury via basal fasting measurements. Hyperprolactinemia definition: PRL >25ng/mL.
Outcome Measure: Incidence of hyperprolactinemia.

  1. At T1, hyperprolactinemia (non-drug related) was seen in 9 patients, and in another 7 taking hyperprolactinemia-inducing drugs.
  2. At T2, hyperprolactinemia was still present in 10 patients, 4 of whom were taking hyperprolactinemia-inducing drugs.

Agha et al. (2005)
Ireland
Observational
Ninitial=50, Nfinal=48

 

 

Population: TBI; Mean Age=37yr; Gender: Male=38, Female=12; Median Time Post Injury=12d; Injury Severity: Moderate=18, Severe=32.
Intervention: PRL levels were assessed at acute phase, and at 6 and 12mo post injury via basal blood collection. Criteria for hyperprolactinemia were not specified.
Outcome Measure: Incidence of hyperprolactinemia.

  1. 26 (52%) of 50 patients developed hyperprolactinemia in the acute phase, persisting in 6 patients into 12 mo follow-up.

  2. Hyperprolactinemia was not associated with age, sex, BMI, GCS score, or the presence of other pituitary hormone deficiencies.

     

Aimaretti et al. (2005)
Italy
Observational
N=102

Population: ABI; TBI Group (n=70): Mean Age=39.31yr; Gender: Male=50, Female=20; Injury Severity: Mild=33, Moderate=22, Severe=15; SAH Group (n=32): Mean Age=51.9yr; Gender: Male=12, Female=20.
Intervention: PRL levels assessed 3 and 12mo post injury in patients with TBI or SAH. Criteria for hyperprolactinemia not specified.
Outcome Measure: Incidence of hyperprolactinemia. 

TBI Group (n=70):
1. Percentage of patients with post-TBI hyperprolactinemia increased from 4.2% at 3mo to 5.7% at 12 mo.

SAH Group (n=32):
2. Percentage of patients with post-SAH hyperprolactinemia stayed the same from 3mo to 12mo (3.1%).

 

Bondanelli et al. (2004)
Italy
Observational
N=50

Population: TBI; Mean Age=37.6yr; Gender: Male=40, Female=10; Severity of Injury: Mild=16, Moderate=7, Severe=27.
Intervention: PRL levels were assessed at least once between 12 and 64mo post injury to assess the frequency of hyperprolactinemia. Baseline blood samples of PRL were obtained 3× at 15min intervals. Hyperprolactinemia definition: basal PRL >2–16µg/L (men); basal PRL >4–24 µg/L (women).
Outcome Measure: Incidence of hyperprolactinemia. 

  1. Plasma PRL level was slightly elevated in 4 (8%; 3 males) patients, and low in 4 patients (8%; 3 males).

Agha et al. (2004)
Ireland
Observational
N=102

Population: TBI; Median Age=28yr; Gender: Male=85, Female=17; Median Time Post Injury=17mo; Median GCS=8. 
Intervention: PRL levels were assessed at least 6mo post injury via baseline serum samples. Hyperprolactinemia definition: basal PRL >2.3–11.5ng/mL (men); >2.5–14.6ng/mL (women).
Outcome Measure: Incidence of hyperprolactinemia.

 

  1. 12 patients had hyperprolactinemia, which was not associated with age, GCS score, cerebral edema, or operative mass evacuation (p>0.05).

Lieberman et al. (2001)
USA
Observational
N=87

 

Population: ABI=17, TBI=70; TBI Group: N=70; Mean Age=31.5yr; Gender: Male=46, Female=24; Severity of Injury: Severe=32, Mild/Moderate=6 (only this data available); Mean Time Post Injury=49 mo.
Intervention: PRL levels were assessed post injury. Hyperprolactinemia definition: PRL >0.12–0.66nmol/L (men); PRL >0.12–0.79nmol/L (women).
Outcome Measure: Incidence of hyperprolactinemia.

  1. PRL was mildly elevated in 6 males, 5 of whom were taking medications known to elevate PRL. Only 1 female patient developed hyperprolactinemia.
  2. All men with hyperprolactinemia had normal testosterone concentrations (9.7–30.5nmol/L).

     

Kelly et al. (2000)
USA
Observational
N=22

Population: Head Injury; Mean Age=28yr; Gender: Male=18; Female=4; Median Time Post Injury=26mo.
Intervention: PRL levels were assessed post injury via TRH stimulation test. Normal response to TRH stimulation was defined as PRL 1.6–21.1ng/mL.
Outcome Measures: PRL response. 

  1. No patients showed an abnormal rise or insufficient response in PRL to TRH stimulation.