Hypothalamic Pituitary Adrenal Axis and Prolactin Abnormalities in Suicidal Behavior
Pp. 246-253 (8)
Gianluca Serafini, Paolo Girardi, Denise Erbuto, David Lester and Maurizio Pompili
Hypothalamic Pituitary Adrenal (HPA) axis hyperactivity measured with the
dexamethasonesuppression test and the dexamethesone/CRH test may be found to have some predictive power
for suicidal behavior in 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 be
associated with the increased production of pro-inflammatory cytokines, which were reported both in major
depression and suicidal behavior. Although no studies have been done to determine whether antemortem
physical stress may be detected by raised post-mortem PRL, this would be of great interest for physicians.
Suicidal behavior, stress, prolactin, HPA axis.
Department of Neurosciences, Mental Health and Organs Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Italy