Hypothalamic pituitary adrenal axis and prolactin abnormalities in suicidal behavior

CNS Neurol Disord Drug Targets. 2013 Nov;12(7):954-70. doi: 10.2174/18715273113129990098.

Abstract

Hypothalamic-Pituitary-Adrenal (HPA) axis hyperactivity measured with the dexamethasone suppression test and the dexamethesone/CRH test may have some predictive power for suicidal behavior in patients with mood disorders. Increased prolactin (PRL) levels may be related both to physiological and pathological conditions. HPA-axis abnormalities and increased levels of PRL may coexist, and common neuroendocrine changes may activate both HPA axis and PRL release. HPA-axis hyperactivity is presumably present in a large subpopulation of depressed subjects. Suicidal behavior is considered to be a form of inward-directed aggression, and aggressive behavior has been connected to high androgen levels. However, lower plasma total testosterone levels have also been reported in subjects with depression and higher suicidality. Lipid/immune dysregulations, the increased ratio of blood fatty acids, and increased PRL levels may each be associated with the increased production of pro-inflammatory cytokines, which have been reported in patients with major depression and patients engaging in suicidal behavior. Although no studies have been done to determine whether ante-mortem physical stress may be detected by raised post-mortem PRL, this would be of great interest for physicians.

Publication types

  • Review

MeSH terms

  • Biomarkers / metabolism
  • Dexamethasone
  • Humans
  • Hyperprolactinemia / metabolism*
  • Hypothalamo-Hypophyseal System / metabolism*
  • Pituitary-Adrenal System / metabolism*
  • Prolactin / metabolism*
  • Suicide*
  • Suicide, Attempted*

Substances

  • Biomarkers
  • Dexamethasone
  • Prolactin