Postmortem prolactin as a marker of antemortem stress

Aim-To determine whether raised prolactin concentrations could be identifie d using postmortem venous blood and whether the level of prolactin correlat ed with antemortem stress. Methods-Blood was obtained from the right femoral vein of 100 random adult necropsy cases, all of whom had been dread less than four days. Prolactin w as deter mined in the samples by microparticle immunoassay. The levels of p rolactin obtained were then analysed in relation to sex and cause of death, with particular emphasis on a history of antemortem stress and drug use. Results-Prolactin in all cases of trauma was in the normal range (up to 500 mU/l). In cases of sudden unexpected deaths the mean concentration was 533 mU/l (95% confidence interval (CI), 372 to 694 mU/l). Postoperative deaths or cases with chronic disease had a mean value of 1027 mU/l (95% CI, 735 t o 1319 mU/l). cases of suicide had a mean value of 1398 mU/l. Analysis of t he suicides by sex showed a significant difference, the mean in female case s being 2072 mU/l compared with 692 mU/l in male cases. In three of the fou r female suicides with: the highest prolactin, the hyperprolactinaemia migh t have been attributable to a drug effect,but one case still had unexplaine d hyperprolactinaemia. Conclusions-It is possible to detect prolactin reliably in postmortem venou s blood samples. Prolactin values at necropsy differ according to the cause of death, with markedly higher values in postoperative deaths and in the c hronically ill. Hyperprolactinaemia in cases of suicide is likely to result from the effects of the drugs used, but the levels were higher than previo usly reported.