Endocrine Abstracts

Introduction

Psychological disorders may be expected in patients with hyperprolactinemia. Indeed, they generally have poor quality of life, anxiety, depression and certain personality troubles. Dopamine agonists are the first-line treatment of prolactinoma. Recently, an increasing number of reports emphasized on dopamine agonists psychological side effects. Effectively, some patients develop de novo psychiatric symptoms or have exacerbation of pre-existing conditions during dopamine agonist therapy. We report the case of a patient with prolactinoma who developed a psychiatric disorder after cabergoline therapy initiation.

Observation

A 42-year-old woman was referred to our department for pituitary apoplexy. Her past medical history revealed a type 2 diabetes mellitus. She presented with headaches and disturbed vision. Pituitary MRI showed a giant pituitary adenoma with hemorrhagic necrosis extending to the sphenoid sinus and optic chiasm, and complicated by hydrocephalus. On physical examination, she had a body weight of 75 kg, a body mass index of 27 kg/m², a blood pressure of 120/70 mmHg. Biological investigations revealed hyperprolactinemia (2975 ng/ml) with gonadotropic deficiency. After ruling out a neurosurgical indication, the patient was put on dopamine agonist therapy (Cabergoline 1 mg/ week). One day after treatment initiation, the patient developed an acute delirium with temporo-spatial disorientation and a suicide attempt. No further treatment was needed, just a close follow up. One week after, neurological and psychological condition was stabilized.

Conclusion

Patients with hyperprolactinemia receiving dopamine agonists may develop changes in mood and behavior regardless of prior psychiatric history. Larger prospective controlled clinical studies are needed to delineate the prevalence of these psychiatric complications and to assess their appropriate management.