A group of Italian investigators headed by Nicoletta Sonino (University of Padova) has performed the first controlled investigation on the relationship between stressful life events and an endocrine disease characterized by increased prolactin levels (hyperprolactinemia).
Little is known about the relationship between recent life events and onset of hyperprolactinemia, despite the well-known effect of acute psychological stress on prolactin levels in healthy subjects. Recent life events in patients with hyperprolactinemia compared to healthy controls were therefore investigated in a case-control study.
52 consecutive patients with hyperprolactinemia and 52 healthy subjects matched for sociodemographic variableswere enrolled. Nineteen patients (18 F/1M) had no pituitary tumor and were diagnosed as suffering from idiopathic hyperprolactinemia. Patients with additional pathology or with high prolactin due to medications were excluded. All patients were interviewed by Paykel Interview for Recent Life Events while on remission after surgery or pharmacological treatment. The time period considered was the year preceding the first signs of hyperprolactinemia, and the year before interview for controls.
The results showed that patients with hyperprolactinemia reported significantly more life events than control subjects (P<0.001). The same significant difference compared to controls applied to patients with (n=16) and without (n=36) depression. All categories of events (except events that were likely to be under the subject’s control) were significantly more frequent. There were no significant differences between patients with prolactinoma (n=33) and those with idiopathic hyperprolactinemia (n=19).
Within the complexity of phenomena implicated in the pathogenesis of hyperprolactinemia, our findings emphasize a potential role of emotional stress in either prolactin secreting pituitary tumors or idiopathic hyperprolactinemia. Appraisal of life stress may have implications in clinical assessment (e.g., functional hyperprolactinemia) and decisions (e.g., termination of long-term pharmacological treatment). High prolactin levels may interfere with the menstrual cycle and fertility. It is conceivable that a reduction in life stress may be beneficial.