EMOTIONAL ASPECTS OF HYPERPROLACTINEMIA

Patients with hyperprolactinemia often present with emotional difficul ties. These occasionally persist even after successful treatment. Insi ght into the roots of their diseased state makes a difference in the h andling of all cases, but becomes crucial in the not-so-rare situation s in which the normalization of hormonal levels is not followed by a f eeling of cure. This chapter attempts to provide details, discuss and situate in context the following blocks of pertinent information: (1) prolactin acts upon the central nervous system and variations in its c oncentrations do affect mood, emotions and behavior; (2) most actions of prolactin are directed to metabolical and behavioral adaptation to pregnancy and the care of the young; (3) even in the absence of pregna ncy prolactin secretion responds to environmental stimuli under specif ic conditions. Whether adaptive, as in the case of surrogate maternity , or pathological, as in the case of pseudopregnancy, prolactin respon ds to a perceived need to take care of a child; (4) the facts that the clinical onset of prolactinomas often follows life-events and that th ese tumors occur preferentially in women brought up under specific con ditions suggest the possibility that psychological factors may predisp ose to prolactinomas; (5) dealing with individual cases requires the p erception that the relations between prolactin, emotions and feelings are circular, i.e., prolactin affects the brain and mood but, on the o ther hand, personality traits and environmental factors may stimulate the secretion of prolactin and may play a role in the genesis of the d isease.