Talk:Prolactin

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[edit] prolactin elevation in celiac disease

Active ceoeliac disease added. Here are references for those in doubt:

• Reifen, R.; Buskila, D.; Maislos, M.; Press, J. & Lerner, A. Serum prolactin in coeliac disease: a marker for disease activity. Arch Dis Child, 1997, 77, 155-7

• Várkonyi, A. & Falkay, G. [Hyperprolactinemia in children with celiac disease] Monatsschr Kinderheilkd, 1984, 132, 547-9

212.202.0.156 10:19, 13 August 2005 (UTC)

Doubt is not the issue. The fact is that you are not providing any context. What does anyone care for the prolactin levels? There are 10,000s of diseases that could potentially affect prolactin levels, from anemia to Zollinger-Ellison syndrome. What is your point? Why does this snippet of scientific knowledge deserve mention in this article? JFW | T@lk 21:18, 14 August 2005 (UTC)

(1) Context: Coeliac disease is much more common than for example pituitary adenomas. So, why shouldn't it deserve to be mentioned? (2) If an article for an encyclopedia doesn't attempt to be at least a little bit complete it shouldn't be written at all. It's a question of quality IMHO.

212.202.201.235 22:35, 14 August 2005 (UTC)

A pituitary adenoma directly produces prolactin. Anything else and we're arguing about why celiac disease deserves any more mentioning than xyz disease that also raises prolactin levels. Why is it interesting that celiac disease causes raised prolactin levels? Alex.tan 01:46, August 15, 2005 (UTC)

The section where I made the entry is "Hyperprolactinemia". I think it would make sense to give more than only one or two causes for hyperprolactinemia in such a section, coeliac disease being one of the more common causes. Other causes should be given as well in order to better reflect the current state of scientific research. To be more up-to-date would help to raise the usefulness and quality of the article. Nussey/Whitehead (and other books from PubMed's bookshelf) for example would be a good starting point for looking at what to add to the article, e.g. Major factors controlling prolactin secretion and causes of hyperprolactinemia. 212.202.0.165 10:09, 15 August 2005 (UTC)

So the question comes back to you, why does this not even mention coeliac? Can't we just agree to leave it out? JFW | T@lk 22:37, 15 August 2005 (UTC)

I can't tell you why Nussey/Whitehead (2001) didn't include it in their list. But a book has always limited space and authors have always limited capacities. It's only natural that they focus on selected issues. Two of the advantages of a collaborative online encyclopedia are more space and more authors. So, more issues can be, and should be IMHO, picked up and discussed. To "just...leave it out" is perhaps an economic decision, but not a scientific one. The "leave it out" approach is hardly appropriate for an encyclopedia that once set out to collect and distribute the knowledge of the world...

212.202.210.75 14:45, 16 August 2005 (UTC)

Dear 212.202.210.75, you're chewing a very old Wikipedia hot potato. Wiki is not paper, but it is also not a random collection of information. On the balance of things, I would discourage the mention of coeliac for the following reasons:

• Its exact prevalence in coeliacs, and its contribution to hyperprolactinaemia is unknown.
• Its clinical significance is undetermined, and likely to be limited.
• Why would you determine prolactin in a coeliac if they do not have menstrual, hypogonadic of pituitary symptoms? JFW | T@lk 16:05, 16 August 2005 (UTC)

"Oldies but goldies." I would suggest the opposite, i.e. not only including c.d. but other diseases with hyperprolactinemia as well. The lack of statistical data is no reason for dismissing the fact. Because Wikipedia isn't a clinical handbook but rather addressing a broad circle of readers I can't see any problem with mentioning the fact. And you probably will agree that hyperprolactinemia -whatever the cause- is of clinical significance. Regarding your question, the answer is: e.g. in differential analysis of growth retardiation/hypogonadism of unknown etiology in children. C.d. is quite often overlooked as a cause. Another reason is detection of late-onset c.d., overlooked even more often.

212.202.0.202 09:09, 17 August 2005 (UTC)

I'm with JFW. What's the significance, clinical or otherwise, of hyperprolactinemia in celiac disease? Btw, "lack of statistical data" usually equals "insufficient evidence for this situation" rather than claiming this as fact. Alex.tan 14:18, August 17, 2005 (UTC)

It's time to ask Alteripse. He's a pediatric endocrinologist. JFW | T@lk 18:17, 17 August 2005 (UTC)

I have just reviewed what appear to be the major research reports and editorials on this topic PMID 14500322, PMID 14984168, PMID 9867122, PMID 9301358, PMID 6384457, PMID 15774013. Although it dates back to 1981, I have to admit to not having heard of this association and found it interesting. For another physician unfamiliar with the topic, I would compare it to the use of a sedimentation rate as a very crude indicator of "disease activity" for a patient with lupus or inflammatory bowel disease. Several reports suggest that it may be elevated in patients with active inflammation and villous damage from gluten but that it usually returns to normal when the patient follows a gluten free diet and the intestinal villi recover. In terms of sensitivity and specificity it is better compared to incomplete dex suppression as an test for depression rather than the equivalent of a HbA1c for diabetes care. Not all reports confirmed this finding and even after 20 years it clearly has not become a widely used measure of disease activity in GI clinics caring for children with celiac disease. It deserves at most a single sentence in a lengthy article about celiac disease or prolactin as a finding of current research interest whose clinical significance and usefulness has not yet been settled. I would certainly not rate it in the top 100 pieces of information for general articles about either celiac or prolactin. Is that a helpful synopsis? alteripse 01:57, 18 August 2005 (UTC)

Thanks. That sounds like a good summary. Alex.tan 06:17, August 18, 2005 (UTC)

Just a short update (references from Pubmed).

• Stazi AV, Trinti B: [Reproductive aspects of celiac disease]. In: Ann Ital Med Int. 2005 Jul-Sep;20(3):143-57. [Article in Italian]

• Pynnonen PA, Isometsa ET, Verkasalo MA, Kahkonen SA, Sipila I, Savilahti E, Aalberg VA: Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. In: BMC Psychiatry. 2005; 5: 14. [1].

Both articles refer to prolactin in the context of coeliac disease.

212.202.210.32

As this is a fairly obscure connection unknown to most pediatric endocrinologists and gastroenterologists, curiosity compels me to ask the following questions:

1. Why do you think after nearly 25 years, the studies still look the same-- there is almost nothing in the most recent studies that wasn't implied by the early ones.
2. There were also reports in the 1970s suggesting that prolactin might be useful in confirming that a spell was an epileptic spell, but it never caught on among neurologists. Do you think we should put that in also?
3. Why do you think prolactin has not been adopted as useful in the clinical care of children with celiac disease by pediatric gastroenterologists?
4. Finally, why are you so heavily invested in publicizing this connection?

Thanks for your answers. alteripse 18:59, 20 November 2005 (UTC)

The bit about seizures is actually at the end of the article; I've heard of this use of prolactin quite frequently, either positively or negatively. There is a reference (Ahmad et al) in the psychogenic non-epileptic seizures article. JFW | T@lk 20:14, 20 November 2005 (UTC)

Are you implying that I should actually read an article before commenting on it? -and don't you want to know the answers to those questions? alteripse 20:19, 20 November 2005 (UTC)

Regarding Alteripse's questions:

1. If there is any causality I wouldn't expect different outcomes after 25 or after 50 years.
2. I would suggest to include every single piece of scientific knowledge that could contribute to a better understanding of the possible causes of unusual levels of prolactin. There is plenty of room here to mark entries appropriately as occurring more commonly or rarely -- no need to keep the knowledge secret. If nobody ever incorporates new knowledge there will be no gain of new insight, no progress.
3. Good question! But I'm the wrong person to ask. I can only speculate about the reasons. A starting point for an explanation could be that it is possibly a bootstrapping problem: Because of "most pediatric endocrinologists and gastroenterologists" didn't read or hear about it, they can't put it more frequently into practice. And because of it is so rarely written about this "obscure connection", they usually won't read or hear about it. But then that's only speculation.
4. As a scientist, I'd prefer the picture to be more complete. I want to quote from other articles here to underline the importance of the problem:

"The delay in diagnosis of 106 patients with adult coeliac disease, diagnosed between 1976 and 1980, was studied. Overall, delay in diagnosis was 11 +/- 10.6 years, being considerably greater in females (12.8 +/- 7.8 years) than in males (3.5 +/- 9.8 years). Most of this delay occurred prior to hospital referral, although that following referral to hospital clinics was still significant (1.8 +/- 4.8 years). The most common presenting complaints were lassitude (75%) anaemia (65%) and flatulence (50%). Typical gastro-intestinal symptoms were relatively uncommon and mild, but when present led to a more speedy diagnosis. It is concluded that, despite advances in modern diagnostic procedures, little progress has been made in hastening the diagnosis of coeliac disease." [2]

That was in 1983. Since then, the situation has not much improved:

"Because the symptoms of celiac disease are vague, patients can complain for years before the diagnosis is made. Often, they are told they have irritable bowel disease or anxiety disorder. Doctor shopping is frequent." (1997) [3]

There are current studies with similar findings and conclusions.

I have made the acquaintance of a few people who are affected by atypical c.d. At least three of them had severe problems (not only) due to raised levels of prolactin prior to a change in their diet. (In one case the necessary medication with dopamine agonists to stop lactation brought almost no result. In most cases, however, prolactin had not been measured at all.) Afterwards, i.e. after maintaining a cereal-free diet for some months, the values (prolactin and others) normalized and the symptoms improved. But it was the patients who had to tell their physicians what was going on and not the other way around. Most of them had to suffer badly before -- for nine years on average. And that bothers me. As a human being I would say that if there is any statistical relevance of the connection between raised levels of prolactin and celiac disease it may help at least a few people to get the right diagnosis more timely. To make them suffer less. Withholding information wont't help. And it's not scientific either.

BTW: October was, once again, "Celiac Awareness Month". [4] 212.202.198.158 10:21, 21 November 2005 (UTC)

Thanks for an elaborate answer but it answered a different question than I asked. I would dispute a point and hone the main unanswered question. In our hospital pediatric endocrinologists and gastroenterologists have indeed been talking to each other about celiac disease in recent years. It is the hottest GI topic in endocrinology, as we have over the last few years begun to adopt yearly celiac screening for all children with type 1 diabetes. This has involved scrutiny of screening tests as well as prolonged discussion over the value of making the diagnosis in the asymptomatic. Since the 1970s, endocrinologists have routinely looked for celiac disease in unexplained growth failure, in unexplained vitamin D deficiency, and in diabetic children with abdominal symptoms. The gastroenterologists have long favored antibody screens rather than hormone screens as being more sensitive and specific, and even endocrinologists used the anti-gliadin antibody in the 1980s, anti-endomysial antibodies in the 1990s, and more recently anti-tissue transglutaminase IgG and IgA. So my question and implied criticism were focused very specifically on the prolactin test, not on the value or importance of making the diagnosis of celiac as you answered. There are tests that are so valuable that they become adopted quickly and there are those that never become popular in practice, and the prolactin is clearly in the latter category. It seemed strange to me that someone would so persistently be pushing a really obscure piece of information that has not been found useful by the specialists most involved. alteripse 11:44, 21 November 2005 (UTC)

Maybe you got me a little bit wrong. What I would suggest is to mention that in cases of inexplicable hyperprolactinemia searching for c.d. could make sense. Nothing more. But nothing less, too. To provide just one more clue for those seeking information.

Regarding your last contribution...

By my knowledge the antibody tests are quite reliable but nevertheless they can not provide 100% certainty (as many other tests can't). Tests fail. Individual conditions matter. For example in cases of selective IgA deficiency, diagnosis is harder. Sometimes the results of IgX tests fall in a grey area (depending on national standards) and biopsy is inconclusive. Most physicians tend to exclude c.d. in such cases. And not in every country IgX tests are common practice at all.

Also there are cases of other illnesses in which the co-occurence of c.d. is not detected, not even thought about. Take Grave's disease as an example. One of the above mentioned acquaintances suffered for almost 10 years from diarrhoea, hallucinations and other symptoms. She has Grave's disease since she was 9 (she is now in her mid-thirties) and was lately diagnosed with IBS, malnutrition, and psychotic disturbances. Four weeks of strictly gluten-free diet greatly improved her condition. No more diarrhoea, no more hallucinations. (But even tiny doses of gluten in her food -those "traces" mentioned in the small-print of the food packages- can give her a new break-down. She has learned that lesson the hard way and now she is most careful.)

For years she has been a member of a self-help group and so she told the other members about her experiences. She explicitely asked them whether they had been screened for c.d. The result, you guess it, was, no, they hadn't. And the co-occurrence of Grave's disease and c.d. isn't so infrequent at all (just browse PubMed). A screening would make sense [5].

But it took years to arrive at such insight. Maybe it will also take years to start looking for c.d. in cases of inexplicable hyperprolactinemia. 212.202.198.158 12:46, 21 November 2005 (UTC)

But what does Grave's have to do with prolactin? You have cited no evidence that checking for coeliac disease in unexplained hyperpprolactinaemia is actually sensible. What is the diagnostic yield? Are you suggesting everyone with unexplained symptoms should go on a gluten-free diet? JFW | T@lk 00:03, 22 November 2005 (UTC)

In at least some cases of c.d. the prolactin level is raised significantly. It normalizes after maintaining a gluten-free diet. That is what the literature shows (consistently for almost 25 years). Hyperprolactinemia may point to c.d. So if you have to explain what causes hyperprolactinemia in a patient you should consider to rule out, among other possible causes such as adenoma, c.d. To quote myself: "What I would suggest is to mention that in cases of inexplicable hyperprolactinemia searching for c.d. could make sense." I don't want to suggest anything else. (The example of Grave's disease should only illustrate that what was obscure some years ago is now recommended as a standard test.) 212.202.198.158 01:05, 22 November 2005 (UTC)

So I will ask you again: what percentage of hyperprolactinaemic patients with no obvious cause turns out to have CD? JFW | T@lk 01:20, 22 November 2005 (UTC)

[edit] Prolactin in non-mammals

This article seems to treat prolactin as being peculiar to mammals, or even to humans (the article should clearly indicate when humans are being discussed, as opposed to mammals in general), but the DVD The Blue Planet: Seas of Life: Seasonal Seas / Coral Seas, in the Fact Files part of the Special Features section, says:

Male seahorses even release the same hormone—prolactin—as female humans.

If this is literally true, it seems some expansion of the scope of the article is called for. - dcljr (talk) 00:35, 7 August 2006 (UTC)

[edit] What to include/exclude...the old arguement.

Speaking as an educated non-specialist, I think there these are important points:

One of the main advantages of an online encyclopedia is that it can, in theory, be kept up to date keeping nearly even with new research. Therefore, items with known correlations should be included somewhere in the article, or at least in a page linked to the article. When we know only part of the relationship, we should put what we know, and update it as new data is learned.

Of course, one of the many forms of update will include removing (or better moving to another page and referencing under 'history') research which is, on reconsideration not accurate.

One reason for saving the history is that sometimes, a 'blind-alley' turns out not to have been so blind, and to leave out mention of the historical view of the subject, the new researchers will have less of an idea of what data has been collected.

Another is that studies often collect data which might be viewed from a different perspective and ad insight to some other unrelated study.

What has to happen is that historical belief has to be separated from the current understanding.

We do not talk about physics on the human level (i.e. Levers & other simple machines) which work well under the Newtonian physics in terms of quantum physics, even though the end result is the same, and the Newtonian physics is, on some level, an 'inaccurate' model of the process. Some models are easier to understand and apply than others and they are used where they do not directly contradict 'more complete' models.

An encyclopedia, by nature, is an attempt to collect as much as possible into a limiteds space. This, because data storage space is not the same as physical storage, is no longer a correct way to define encyclopedia, since an online version can be both 'unabridged' and 'comprehensive.' Ideally, an online encyclopedia either contains or is linked to everything which has ever been said about a topic.

The question is not what to include, it is WHERE to include things.

The main entry should contain multiple references to causes for this syndrome, but they ought to be cases where there is a clear correlation. Less clearly correlated cases should be relegated to a lower level page, or to links to external studies.

IMHO Wizodd 18:05, 10 March 2007 (UTC)