Hyperprolactinemia with Antipsychotic Drugs in Children and Adolescents

The practice of psychiatry and the shift to noninstitutional care of severe psychiatric disorders are the result of antipsychotic medications, beginning with chlorpromazine in the early 1950s. Approximately 10 other drugs, known as first-generation or typical antipsychotics, followed over the subsequent 30 years. These drugs were effective in treating positive symptoms of psychosis such as hallucination and delusion but did not alleviate the negative symptoms of withdrawal, apathy, cognitive impairment, or loss of affect. Furthermore, they were associated with frequent extrapyramidal symptoms, including acute dystonia, akinesia, akathisia, tardive dyskinesia, and parkinsonism. A series of newer drugs began emerging in 1989, referred to as second generation or atypical antipsychotics, thought to be more effective than the older agents in alleviating the negative, cognitive, and affective symptoms, with fewer extrapyramidal adverse effects [1].The antipsychotic drugs differ in their side effect profiles, as they affect different neuroreceptors (histamine, α-adrenergic, muscarinic, dopamine, or serotonin). The principal concern for endocrinologists with the newer drugs has been the metabolic effects of weight gain, glucose intolerance, hyperlipidemia, and hypertension [2]. This is particularly important with the increasing use of these agents in pediatrics to treat bipolar disorder, schizophrenia, autism, oppositional and other behavior disturbances, Tourette disorder, and pervasive developmental disorder. In 2003-2004, 1% of all pediatric visits resulted in the prescription of atypical antipsychotic medication [3]. The importance and implications of the metabolic side effects of atypical antipsychotics for pediatric patients have been recently reviewed [1, 4].This paper will examine the side effect of hyperprolactinemia in children and adolescents treated with antipsychotic drugs.Prolactin, a 198-amino acid polypeptide, is secreted by the anterior pituitary lactotroph