ABSTRACT Dizziness is a common complaint in primary care clinics and can enter the diagnostic profile of different pathologies spanning from psychiatric problems to vestibular dysfunction.

Episodes of vertigo in Ménière's patients are often reported to be triggered by stress but no physiological data are available to account for the subjective link. The study involved 42

Ménière's patients hospitalized for neurectomy of the vestibular nerve for relief of incapacitating vertigo. In addition 18 patients with neurinoma of the vestibular nerve and 12

patients with facial spasm, who underwent surgery, served as controls. A blood sample was taken on the day of surgery in order to determine the level of battery of different stress hormones.

opting for surgery in Ménière's patients. SIMILAR CONTENT BEING VIEWED BY OTHERS DIAGNOSIS AND MANAGEMENT OF PROLACTIN-SECRETING PITUITARY ADENOMAS: A PITUITARY SOCIETY INTERNATIONAL

CONSENSUS STATEMENT Article 05 September 2023 RELATION BETWEEN VITAMIN D DEFICIENCY AND BENIGN PAROXYSMAL POSITIONAL VERTIGO Article Open access 19 August 2021 A MULTI-CENTER STUDY

EVALUATING THE CORRELATION BETWEEN MEIBOMIAN GLAND DYSFUNCTION AND DEPRESSIVE SYMPTOMS Article Open access 10 January 2022 MAIN Vertigo is episodic dizziness, considered as an imbalance

originating within the vestibular system (Baloh 1998). Peripheral vestibulopathologies, (including benign positional vertigo, Ménières disease, vestibular neuritis, labyrinthitis) can

account for 35–55% of patients, psychiatric disorders for 10–25%, cardiovascular disease 5%, and brain tumors less than 1% while 10% elude diagnosis (Hoffman et al. 1999). We were

particularly concerned with Ménière's patients who present vertigo together with fluctuating hearing loss and tinnitus. The cause of this inner ear dysfunction is not known. It starts

as monolateral and evolves to bilateral in 30–50% of patients (Paparella 1991). In cases of incapacitating vertigo, selective surgery involving neurectomy of the vestibular nerve can be

opted for, when no other medical approach has succeeded. Emotional stress has long been known to be a precipitating factor and a psychosomatic aspect of Ménière's disease is one factor,

which has long been recognized (Fowler and Zeckel 1952). The association between “dizziness” and “psychiatric dysfunction” has recently come to the forefront of medical discussion (Yardley

et al. 1998, 1999; Moss-Morris and Petrie 1999). One unique time-series analysis based on self-assessment, on stress and symptoms of Ménière's disease clearly associated stress with

symptoms and in particular with vertigo in 13 out of 20 patients (Andersson et al. 1997). It seemed timely to investigate some objective measure of stress and to this end we investigated the

level of a battery of stress hormones. METHODS This study was carried out over a period of two years. The patients were recruited from the Department of Otolaryngology where they had been

classified as Ménière's patients with various degrees of hearing loss, tinnitus, and incapacitating vertigo, and fitted the guidelines for the diagnosis of Ménière's disease as

defined by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology – Head & Neck Surgery (Committee on Hearing and Equilibrium 1995). The patients underwent

surgery to relieve incapacitating vertigo, which in all cases handicapped their private and professional lives and which in 60% of the cases rendered driving a vehicle difficult or

impossible. A total of 16 males and 26 females had all been scheduled for and underwent neurectomy of the vestibular nerve. Before surgery a final audiogram was determined and vestibular

function was assessed by videonystagmography as well as dynamic posturography. Since the level of stress hormones might be acutely biased by the anxiety of surgery, we included patients with

acoustic neurinoma (n = 18; 5 males, 13 females) and with facial spasm (n = 12; 5 males, 7 females) who were also scheduled for a similar surgical approach, for comparison. The age ranges

were similar as presented in Figure 1. A blood sample was taken on the morning prior to surgery and pre-medication. The blood was drawn into dry vacuum tubes for all hormones except for

adrenocorticotrophic hormone (ACTH) which was collected in tubes containing EDTA immediately chilled and sent to the biochemistry laboratory for processing. The samples were centrifuged at

2500 G for 10 min and supernatants frozen at −80°C for later analysis. Concentrations of cortisol, prolactin, ACTH, growth hormone (GH), and β-endorphin–like immunoreactivity (β-ELI) were

analyzed. None of the patients was taking medication, which could have influenced the level of stress hormones. RESULTS Within the battery of stress hormones investigated the different

hormones showed variability between subjects. The data are summarized in Table 1. The most systematic and striking result concerned the level of prolactin and those data were fully analyzed

and presented here. Within the group of Ménière's patients, the level of prolactin was above the reference normal level (20μg/l) in 14 cases. In contrast the level of prolactin was

within the normal range in all patients with facial spasm and only slightly elevated in four patients with neurinoma. The presence of prolactinoma was confirmed by MRI in six out of six

Ménière's patients investigated. The other cases could not yet be followed up, principally because of the retrospective nature of this study. The bilateral audiograms of the

Ménière's patients with prolactin levels greater than and less than 20 μg/l are presented in Figure 2 and Figure 3 respectively. To facilitate the presentation the patient data were

regrouped arbitrarily into two groups: over and under 50 years old. The data suggest that when prolactin was elevated there was better preservation of hearing in the non-operated ear (Figure

2, right column) compared with those cases when prolactin was within the normal range (Figure 3, right column). However, the presentation of the audiogram data according to age is biased by

the fact that high-prolactin group included patients mostly between 50 and 60 years old while the normal prolactin group included patients mostly between 60 and 70 years old. The high

frequency loss might be compounded by age-related presbyacusis. DISCUSSION We investigated the level of a battery of stress hormones in a sample of 42 Ménière's patients with

incapacitating vertigo. The essential finding is that prolactin was abnormally elevated in 14 patients and prolactinoma confirmed in six out of six investigated. The patients with

hyperprolactinemia represents a surprisingly high percentage, close to 30% (and at least 15% with prolactinoma) in our limited sample of patients, which was neither filtered nor selected. In

particular the prevalence of hyperprolactinemia is reported to be 0.4% in an unselected normal population (Biller et al. 1999). Although prolactinomas have been reported to be associated

with tinnitus and fullness of the ear (Dominguez Ugidos et al. 1998) with vertigo (Schaller et al. 1998) and with hearing loss as well as vertigo (Blagoveshchenskaia and Leushkina 1988), the

presence of the prolactinomas in our sample of patients had been ignored. Clearly our data demonstrate that a sub-category of Ménière's patients can present hyperprolactinemia and

prolactinoma. It is known that stress can contribute to hyperprolactinemia (Freeman et al. 2000). The present study cannot determine whether hyper-stressed subjects are prone to develop

Ménière's disease or whether Ménière's disease leads to stress in patients. Clearly the association between vestibular dysfunction and stress is likely to have underlying

neurophysiological mechanism based on central connections beween the inner ear and autonomic nervous system (Baloh 1998; Horner et al. 2001). Dopamine agonist therapy (bromocriptine) is well

known to reduce the size of prolactinomas as well as normalize prolactin levels (Biller et al. 1999). Several lines of research suggest that dopamine has a protective role on cochlear

(Eybalin 1993) and vestibular (Petrosini and Dell'Anna 1993) function. Future research should be aimed at determining the effect of dopamine agonist treatment on symptoms of

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Psychiatric dysfunction and dizziness. _Lancet._ 353: 2069 Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Laboratoire d'Otologie,

Hôpital Nord, Marseille, France Kathleen C Horner Ph.D & Yves Cazals Ph.D * Cnrs UMR 6560, Hôpital Nord, Marseille, France Regis Guieu MD * Service ORL, Hôpital Nord, Marseille, France

Jacques Magnan MD & Andre Chays MD Authors * Kathleen C Horner Ph.D View author publications You can also search for this author inPubMed Google Scholar * Regis Guieu MD View author

publications You can also search for this author inPubMed Google Scholar * Jacques Magnan MD View author publications You can also search for this author inPubMed Google Scholar * Andre

Chays MD View author publications You can also search for this author inPubMed Google Scholar * Yves Cazals Ph.D View author publications You can also search for this author inPubMed Google

Scholar CORRESPONDING AUTHOR Correspondence to Kathleen C Horner Ph.D. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Horner, K., Guieu, R., Magnan, J.

_et al._ Prolactinoma in Some Ménière's Patients — Is Stress Involved?. _Neuropsychopharmacol_ 26, 135–138 (2002). https://doi.org/10.1016/S0893-133X(01)00356-6 Download citation *

Received: 05 May 2001 * Revised: 18 June 2001 * Accepted: 26 June 2001 * Published: 05 July 2001 * Issue Date: 01 January 2002 * DOI: https://doi.org/10.1016/S0893-133X(01)00356-6 SHARE THIS

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Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * Stress * Vertigo * Hearing * Tinnitus * Prolactin * Dopamine