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Cancers Oct 2021To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and... (Review)
Review
To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and meta-analysis according to PRISMA statement was performed. Articles counting more than 30 patients were included. A weighted random effects models was used to calculate pooled outcome estimates. From 459 abstract reviews, 52 retrospective studies were included. Among them, 18 reported on non-functioning pituitary adenomas (NFPA), 13 on growth hormone (GH)-secreting adenomas, six on adrenocorticotropic hormone (ACTH)-secreting adenomas, four on prolactin hormone (PRL)-secreting adenomas, and 11 on craniopharyngiomas. Overall tumor control and five-year progression free survival (PFS) estimate after one GK procedure for NFPA was 93% (95% CI 89-97%) and 95% (95% CI 91-99%), respectively. In case of secreting pituitary adenomas, overall remission (cure without need for medication) estimates were 45% (95% CI 35-54%) for GH-secreting adenomas, 64% (95% CI 0.52-0.75%) for ACTH-secreting adenomas and 34% (95% CI: 19-48%) for PRL-secreting adenomas. The pooled analysis for overall tumor control and five-year PFS estimate after GK for craniopharyngioma was 74% (95% CI 67-81%) and 70% (95% CI: 64-76%), respectively. This meta-analysis confirms and quantifies safety and effectiveness of GK for pituitary tumors.
PubMed: 34638482
DOI: 10.3390/cancers13194998 -
Psychoneuroendocrinology Apr 2022Major depressive disorder is the most common neuropsychiatric comorbidity of human immunodeficiency virus (HIV), and women are more frequently affected in the general... (Review)
Review
BACKGROUND
Major depressive disorder is the most common neuropsychiatric comorbidity of human immunodeficiency virus (HIV), and women are more frequently affected in the general population and among those with HIV. The rate of depression in HIV is three times higher than the general population. Differences in biomarkers in neuroendocrine and inflammatory pathways are one possible explanation for the increased prevalence of depression in individuals with HIV, especially biological women. Therefore, we aimed to perform a systematic review identifying differences in neuroendocrine factors leading to depression in men versus women with HIV.
METHODS
A comprehensive search of 8 databases was performed, followed by title and abstract screening and later full-text screening by two independent researchers. A risk of bias assessment was completed.
RESULTS
Twenty-six full-text articles were included in the review. Significant correlations between depression and neuroendocrine marker levels were found for cortisol (both sexes), testosterone (only in men), oxytocin (only tested in women), and estradiol (only in women). No significant correlation between depression and hormone level was found for prolactin, dehydroepiandrosterone (DHEAS), or sex hormone binding globulin (SHBG). Nearly all studies included only men or women and did not directly compare neuroendocrine markers between the two sexes. One study found that the correlation between cortisol levels and depression scores was stronger in women than men.
CONCLUSION
Neuroendocrine systems are highly active in the brain and important in the development and persistence of mental illness. Given that HIV can, directly and indirectly, impact hormone signaling, it is likely contributing to the high rate of depression in individuals with HIV. However, few studies explore neuroactive hormones in depression and HIV, nor how this connection may differ between the sexes. More high-quality research is needed in this area to explore the link further and inform possible avenues of treatment.
Topics: Biomarkers; Depression; Depressive Disorder, Major; Estradiol; Female; Gonadal Steroid Hormones; HIV Infections; Humans; Hydrocortisone; Male; Sex Characteristics; Sex Hormone-Binding Globulin; Testosterone
PubMed: 35063687
DOI: 10.1016/j.psyneuen.2022.105665 -
Frontiers in Endocrinology 2022Pre-clinical evidence suggests that prolactin has important metabolic functions in pregnancy and postpartum, in addition to lactogenic actions. (Meta-Analysis)
Meta-Analysis
CONTEXT
Pre-clinical evidence suggests that prolactin has important metabolic functions in pregnancy and postpartum, in addition to lactogenic actions.
OBJECTIVE
To explore the relationship between prolactin and maternal metabolic outcomes in human pregnancy and postpartum, particularly in relation to gestational diabetes mellitus (GDM).
DATA SOURCES
MEDLINE OVID, CINAHL plus, Embase.
STUDY SELECTION
Eligible studies included women who were pregnant or up to 12 months postpartum, reporting at least one maternal serum prolactin level in relation to key metabolic outcomes including GDM, glycaemic parameters, obesity, and gestational weight gain.
DATA EXTRACTION
Two independent reviewers extracted data.
DATA SYNTHESIS
Twenty-six articles were included. Meta-analysis showed no relationship between maternal prolactin levels and GDM status, with a weighted mean difference of -2.14 ng/mL (95% CI -12.54 to 8.27 ng/mL, p=0.7) between GDM and controls in early pregnancy (n=3 studies) and -3.89 ng/mL (95% CI, -15.20 to 7.41 ng/mL, p=0.5) in late pregnancy (n=11 studies). In narrative synthesis of other outcomes (due to study heterogeneity and/or lack of data), prolactin levels were not associated with maternal glycaemic or weight-related parameters during pregnancy, but in the postpartum period (particularly with lactation) a high-prolactin environment was associated with low circulating insulin and beta-cell function, and increased insulin sensitivity.
CONCLUSIONS
Current evidence from human studies does not clearly support a relationship between prolactin and metabolic parameters during pregnancy, including with GDM status. Elevated prolactin was associated with lower insulin and beta-cell function and higher insulin sensitivity in the post-partum period, but the direction of causality remains unclear.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier [CRD42021262771].
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Prolactin; Insulin Resistance; Postpartum Period; Insulin
PubMed: 36619539
DOI: 10.3389/fendo.2022.1069625 -
Current Psychiatry Reports Aug 2022Lumateperone (LUM) is the U.S. Food and Drug Administration approved atypical antipsychotic agent for adults with schizophrenia (SCZ) and bipolar depression (for both... (Review)
Review
PURPOSE OF REVIEW
Lumateperone (LUM) is the U.S. Food and Drug Administration approved atypical antipsychotic agent for adults with schizophrenia (SCZ) and bipolar depression (for both bipolar I and bipolar II disorder as as monotherapy or as adjunctive treatment to lithium or valproate). LUM simultaneously modulates serotonin, dopamine, and glutamate neurotransmission. The foregoing pleiotropic mechanism of action is predictive of therapeutic benefits across multiple domains of psychopathology in SCZ (i.e., positive, negative, cognitive, and prosocial symptoms). Herein, the overarching aim is to synthesize the extant literature reporting on the efficacy, safety, and tolerability of LUM in adults with SCZ.
RECENT FINDINGS
Four clinical studies (i.e., three RCTs and one open-label trial) were included in this synthesis. Overall, LUM significantly reduced the severity of SCZ compared with placebo. The open label study provided the real-world effectiveness of shifting stable patients with SCZ to LUM from other atypical antipsychotics. With respect to safety and tolerability profile, LUM demonstrated placebo-level rates of weight gain, metabolic shift, prolactin elevation, extrapyramidal side effects (EPS), and akathisia across short term trials (i.e., 4-6 weeks). Taken together, our results indicate that LUM significantly improves symptoms severity in adults with SCZ. LUM also exhibits a favorable tolerability and safety profile with placebo level rates of weight gain, metabolic disruption, akathisia, extrapyramidal side effects (excluding akathisia), and prolactin elevation. Lumateperone should be conceptualized as a first-line treatment strategy for adults with SCZ.
Topics: Adult; Antipsychotic Agents; Heterocyclic Compounds, 4 or More Rings; Humans; Prolactin; Psychomotor Agitation; Schizophrenia; Treatment Outcome; Weight Gain
PubMed: 35802228
DOI: 10.1007/s11920-022-01344-1 -
Journal of Traditional Chinese Medicine... Oct 2020To summarize and critically evaluate the evidence pertaining to the effectiveness and safety of auriculotherapy for breastfeeding. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize and critically evaluate the evidence pertaining to the effectiveness and safety of auriculotherapy for breastfeeding.
METHODS
We performed a systematic search of 10 databases from their inception dates to May 15, 2017. Randomized controlled trials evaluating the effectiveness and safety of auriculotherapy for breastfeeding were included. Risk of bias was assessed using the Cochrane risk of bias tool.
RESULTS
This review included 31 randomized controlled trials with 5389 participants. Owing to the obvious clinical or statistical heterogeneity, a Meta-analysis was not conducted. Twenty-nine studies compared auriculotherapy plus routine care with routine care alone. No consistent adjunctive effect of auriculotherapy was observed in increasing the volume of milk production (9 studies showed significant results in favor of auriculotherapy and 5 did not) and serum prolactin level (7 studies showed significant results in favor of auriculotherapy and 2 did not), and in facilitating the initiation of milk secretion (10 studies showed significant results in favor of auriculotherapy and 7 did not). Two studies compared auriculotherapy with no treatment. Auriculotherapy as a monotherapy showed significant effects in increasing serum prolactin level and facilitating the onset of milk secretion; however, it was limited and inconclusive because only two studies were included in this comparison. The subgroup analysis of women who underwent cesarean delivery showed inconsistent results with respect to all outcomes. No serious adverse events were reported with the use of auriculotherapy. The methodological quality of the included studies was generally poor.
CONCLUSION
Although some studies showed positive results, no definite conclusion about the effectiveness and safety of auriculotherapy for breastfeeding could be drawn, owing to the low methodological quality of the included studies and the heterogeneity among trials. Large-scale, well-designed studies are warranted on this topic.
Topics: Adult; Animals; Auriculotherapy; Breast Feeding; Female; Humans; Milk; Pregnancy; Prolactin; Randomized Controlled Trials as Topic; Young Adult
PubMed: 33000573
DOI: 10.19852/j.cnki.jtcm.2020.05.002 -
Journal of Personalized Medicine Mar 2023The inadequate efficacy and adverse effects of antipsychotics severely affect the recovery of patients with schizophrenia spectrum disorders (SSD). We report the... (Review)
Review
The inadequate efficacy and adverse effects of antipsychotics severely affect the recovery of patients with schizophrenia spectrum disorders (SSD). We report the evidence for associations between pharmacogenetic (PGx) variants and antipsychotics outcomes, including antipsychotic response, antipsychotic-induced weight/BMI gain, metabolic syndrome, antipsychotic-related prolactin levels, antipsychotic-induced tardive dyskinesia (TD), clozapine-induced agranulocytosis (CLA), and drug concentration level (pharmacokinetics) in SSD patients. Through an in-depth systematic search in 2010-2022, we identified 501 records. We included 29 meta-analyses constituting pooled data from 298 original studies over 69 PGx variants across 39 genes, 4 metabolizing phenotypes of , and 3 of . We observed weak unadjusted nominal significant ( < 0.05) additive effects of PGx variants of , , , , , , and (10 variants) on antipsychotic response; , , , , , , , , , and (14 variants) on weight gain; (one variant) on metabolic syndrome; (one variant) on prolactin levels; and (two variants) on TD; HLA-DRB1 (one variant) on CLA; (four phenotypes) and (two phenotypes) on antipsychotics plasma levels. In the future, well-designed longitudinal naturalistic multi-center PGx studies are needed to validate the effectiveness of PGx variants in antipsychotic outcomes before establishing any reproducible PGx passport in clinical practice.
PubMed: 36983653
DOI: 10.3390/jpm13030471 -
Acta Neurochirurgica Sep 2023Although there is an increasing body of evidence showing gender differences in various medical domains as well as presentation and biology of pituitary adenoma (PA),... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although there is an increasing body of evidence showing gender differences in various medical domains as well as presentation and biology of pituitary adenoma (PA), gender differences regarding outcome of patients who underwent transsphenoidal resection of PA are poorly understood. The aim of this study was to identify gender differences in PA surgery.
METHODS
The PubMed/MEDLINE database was searched up to April 2023 to identify eligible articles. Quality appraisal and extraction were performed in duplicate.
RESULTS
A total of 40 studies including 4989 patients were included in this systematic review and meta-analysis. Our analysis showed odds ratio of postoperative biochemical remission in males vs. females of 0.83 (95% CI 0.59-1.15, P = 0.26), odds ratio of gross total resection in male vs. female patients of 0.68 (95% CI 0.34-1.39, P = 0.30), odds ratio of postoperative diabetes insipidus in male vs. female patients of 0.40 (95% CI 0.26-0.64, P < 0.0001), and a mean difference of preoperative level of prolactin in male vs. female patients of 11.62 (95% CI - 119.04-142.27, P = 0.86).
CONCLUSIONS
There was a significantly higher rate of postoperative DI in female patients after endoscopic or microscopic transsphenoidal PA surgery, and although there was some data in isolated studies suggesting influence of gender on postoperative biochemical remission, rate of GTR, and preoperative prolactin levels, these findings could not be confirmed in this meta-analysis and demonstrated no statistically significant effect. Further research is needed and future studies concerning PA surgery should report their data by gender or sexual hormones and ideally further assess their impact on PA surgery.
Topics: Humans; Male; Female; Treatment Outcome; Prolactin; Retrospective Studies; Pituitary Neoplasms; Adenoma; Hormones; Postoperative Complications
PubMed: 37555999
DOI: 10.1007/s00701-023-05726-z -
Healthcare (Basel, Switzerland) May 2023So far, neuroendocrine studies conducted in schizophrenic patients have yielded conflicting results. Many of these discrepancies may be explained by the diversity of... (Review)
Review
So far, neuroendocrine studies conducted in schizophrenic patients have yielded conflicting results. Many of these discrepancies may be explained by the diversity of factors that influence the hormonal levels (at baseline and in response to pharmacological stimuli), the heterogeneity of the populations studied, the absence of standardization of test challenges and the confounding and long-lasting effects of previous treatments. Numerous studies have used apomorphine (APO) in the evaluation of dopaminergic (DA) function in schizophrenic patients. APO, a direct acting DA receptor agonist, decreases prolactin (PRL) and stimulates growth hormone (GH), adrenocorticotropic hormone (ACTH) and cortisol secretion. Therefore, the magnitude of hormonal responses to APO is an indirect assessment of the functionality of DA receptors at the hypothalamic-pituitary level. This review provides an update on the applications of the APO test in schizophrenia in clinical, pathophysiological and therapeutic fields.
PubMed: 37239772
DOI: 10.3390/healthcare11101487 -
CNS Spectrums Oct 2022Antipsychotic medications are used in a wide range of mental health and neurodevelopmental conditions in children and adolescents. Their efficacy and tolerability with... (Meta-Analysis)
Meta-Analysis Review
Antipsychotic long-term treatment in children and young people: a systematic review and meta-analysis of efficacy and tolerability across mental health and neurodevelopmental conditions.
Antipsychotic medications are used in a wide range of mental health and neurodevelopmental conditions in children and adolescents. Their efficacy and tolerability with long-term use have not been clearly established. We aimed to conduct a systematic review and meta-analysis to evaluate the long-term use of antipsychotics in children and adolescents. All relevant double-blind randomized control trials (RCTs), on any antipsychotic used for 12 weeks or longer in any mental health/neurodevelopmental condition in this age group, were included. We evaluated several efficacy and tolerability measures. Meta-analysis was performed for adverse events. Seven RCTs were identified (n = 939, age = 5-17 years), four on aripiprazole and three on risperidone. All studies reported symptomatic/functional improvements or more time before discontinuation with antipsychotics compared to placebo. Weight gain was identified as a significant side effect with antipsychotics. Serum prolactin was reduced with aripiprazole and increased with risperidone, and abdominal pain/discomfort, respiratory tract infections, were more common with Aripiprazole compared to placebo. Musculoskeletal pain may be more common with aripiprazole compared to placebo. Use of antipsychotics for 12 weeks or longer may be associated with symptomatic/functional improvements, but may be associated with additional side effects compared to short-term treatment. Further research in this population is needed.
Topics: Child; Adolescent; Humans; Child, Preschool; Antipsychotic Agents; Aripiprazole; Risperidone; Olanzapine; Mental Health; Prolactin; Schizophrenia; Benzodiazepines; Randomized Controlled Trials as Topic
PubMed: 34027855
DOI: 10.1017/S1092852921000523 -
Journal of Psychiatric Research Oct 2020We performed a systematic review and meta-analysis of the efficacy and safety of second generation (SG) long-acting antipsychotics (LAIAs) versus first generation (FG)... (Meta-Analysis)
Meta-Analysis Review
Preliminary efficacy and tolerability profiles of first versus second-generation Long-Acting Injectable Antipsychotics in schizophrenia: A systematic review and meta-analysis.
We performed a systematic review and meta-analysis of the efficacy and safety of second generation (SG) long-acting antipsychotics (LAIAs) versus first generation (FG) LAIAs in schizophrenia. We conducted a comprehensive search in PubMed, MEDLINE, EMBASE and PsycINFO until May 2019. Inclusion criteria for randomized trials included: (1) patients ≥18 years with schizophrenia, (2) efficacy evaluated through the Positive and Negative Syndrome Scale (PANSS), (3) safety assessment through clinimetry, laboratory analysis, somatometry or adverse events, and (4) treatment duration ≥12 weeks. Data was synthesized using mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes using a random-effect model. Of 1872 citations, 17 trials were included, and direct comparisons of SG vs FG-LAIAs were observed in 3 (n = 459). SG and FG-LAIAs had similar effects on PANSS scores (MD -1.35; 95% CI -8.33-5.64), tardive dyskinesia (RR 0.99; 95% CI, 0.47-2.07), all-cause discontinuation (RR 1.01; 95% CI 0.75-1.36), discontinuation due to inadequate efficacy (RR 1.13; 95% CI 0.81-1.59) or adverse events (RR 1.08; 95% CI 0.55-2.11). SG-LAIAs reduced the risk of using antiparkinsonian drugs (RR 0.54; 95% CI 0.54-0.76) but significantly increased serum prolactin, weight and BMI. For long-term management, depot preparations of paliperidone, haloperidol, risperidone and fluphenazine were equally effective at symptom control and adherence, with significant differences in their safety profiles. These results however are considerably limited due to the small number of included studies and are therefore preliminary, not generalizable. More clinical trials are required to obtain a broader perspective of SG-LAIAs compared to FG-LAIAs.
Topics: Antipsychotic Agents; Benzodiazepines; Humans; Olanzapine; Piperazines; Schizophrenia
PubMed: 32805530
DOI: 10.1016/j.jpsychires.2020.06.013