The side effects of dopamine receptor agonist drugs in Chinese prolactinoma patients: a cross sectional study

Impulse Control Disorders in Patients With Hyperprolactinemia on Dopamine Agonist Therapy-How Concerned Should We Be?

OBJECTIVE

Dopamine agonists (DAs), including cabergoline and bromocriptine, are the mainstay of treatment for prolactinomas. An underappreciated adverse effect associated with DAs is impulse control disorders (ICDs), characterized by the development of compulsive behaviors, including hypersexuality, pathological gambling, binge eating, and compulsive shopping, among others, which can negatively impact patients' and families' lives. This article reviews the prevalence, risk factors, presumed pathophysiology, and diagnostic and management strategies for ICDs in hyperprolactinemic patients treated with DAs.

METHODS

Electronic literature searches were conducted to retrieve pertinent articles for inclusion in this article.

RESULTS

The reported prevalence of ICDs in patients with prolactinomas or hyperprolactinemia on DAs ranges from 7.5% to 46% across studies, with cabergoline being more commonly implicated than bromocriptine. Younger age, male sex, and specific genetic polymorphisms appear to increase the risk of ICDs. Diagnostic tools, such as the Minnesota Impulse Disorders Interview, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease, the Barratt Impulsivity Scale-11, and computer-based tests, are instrumental in identifying ICDs. Patient education and periodic screening are advisable for early detection. Management strategies for patients who develop ICDs may include a decrease in DA dose or medication discontinuation, and psychiatric evaluation.

CONCLUSION

ICDs may occur in patients with hyperprolactinemia on DAs and negatively influence their lives if undetected. Further studies are needed to fully elucidate the risk factors and underlying mechanisms and to identify effective therapies for managing ICDs in patients with hyperprolactinemia on DAs.

Impulse control disorders in patients with pituitary adenoma managed with or without dopamine agonists: a cross-sectional study from a UK centre

PURPOSE

Studies from various countries raise concerns on the association between dopamine agonist (DA) treatment and impulse control disorders (ICDs) in patients with pituitary adenomas. We investigated the prevalence of ICDs in patients with pituitary adenomas in a UK centre using two instruments applied in clinical practice for assessing ICDs.

METHODS

Cross-sectional study of adults with prolactinoma, acromegaly or non-functioning pituitary adenoma (NFPA) treated or not with DAs in a pituitary centre. Screening tools for ICD were the Minnesota Impulse Disorders Interview (MIDI) and Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS).

RESULTS

Data from 200 patients were analysed [72 prolactinomas (on DA), 71 NFPAs (no DA), 57 with acromegaly (12 on DA)]. The percentage of patients scoring for any ICD was higher in the prolactinoma on DA group compared with the NFPA cases; MIDI 12.7% vs. 1.4% (p = 0.02) and QUIP-RS 46.5% vs. 18.6% (p < 0.001), respectively. DA use was associated with positive scores for all ICDs in the MIDI and with compulsive buying and hobbyism-punding in the QUIP-RS. DA dose or treatment duration were not associated with positive scores. The responses of patients with acromegaly on DA did not differ from those not on these agents in any questionnaire.

CONCLUSIONS

In this sample of UK patients, prevalence of ICDs is higher in prolactinoma patients on DA compared to those with NFPA not on DA. Differences were not observed between patients with acromegaly treated or not with DA. Different ICD assessment tools have an impact on the detected outcomes.

Experience in the Treatment of Male Prolactinomas: A Single-Center, 10-Year Retrospective Study

INTRODUCTION

Male prolactinomas are uncommon and typically macroadenomas with difficult treatment and management. The purpose of this study was to summarize the treatment and management experiences of 254 male prolactinoma patients at a single center.

METHODS

This was a 10-year retrospective study conducted at a single center. A total of 254 male prolactinoma patients were included. Clinical data for all subjects were collected using an electronic medical record system.

RESULTS

A total of 254 male patients with prolactinoma were studied. Their median age at onset was 28.8 years, and median disease duration was 28.5 months. The median PRL levels were 582.0 ng/mL at diagnosis. Their median maximum tumor diameter was 23.0 mm, with macroadenoma accounting for the majority (76.7%). After treatment, the biochemical remission rate with monotherapy was 36.6%, but significantly increased to 60.6% with multidisciplinary treatment (p < 0.001). Knosp 0-2 patients had significantly higher rates of biochemical remission compared to Knosp 3-4 (all p < 0.05). In addition, the maximum diameter of adenoma (B = -0.110, p = 0.008) and cavernous sinus invasion (B = -1.741, p = 0.023) were negatively correlated with postoperative biochemical remission. The maximum diameter of the adenoma (B = - 0.131, p < 0.001) was a negative correlation factor, while treatment duration (B = 0.034, p = 0.002) was a positive correlation factor for biochemical response to medication.

CONCLUSION

Male prolactinoma has a low biochemical remission rate when treated alone, but multitherapy can improve it even more. Surgery may also be considered for male prolactinoma with a micro, and noninvasive tumor after a thorough evaluation.

INTRODUCTION

Male prolactinomas are uncommon and typically macroadenomas with difficult treatment and management. The purpose of this study was to summarize the treatment and management experiences of 254 male prolactinoma patients at a single center.

METHODS

This was a 10-year retrospective study conducted at a single center. A total of 254 male prolactinoma patients were included. Clinical data for all subjects were collected using an electronic medical record system.

RESULTS

A total of 254 male patients with prolactinoma were studied. Their median age at onset was 28.8 years, and median disease duration was 28.5 months. The median PRL levels were 582.0 ng/mL at diagnosis. Their median maximum tumor diameter was 23.0 mm, with macroadenoma accounting for the majority (76.7%). After treatment, the biochemical remission rate with monotherapy was 36.6%, but significantly increased to 60.6% with multidisciplinary treatment (p < 0.001). Knosp 0-2 patients had significantly higher rates of biochemical remission compared to Knosp 3-4 (all p < 0.05). In addition, the maximum diameter of adenoma (B = -0.110, p = 0.008) and cavernous sinus invasion (B = -1.741, p = 0.023) were negatively correlated with postoperative biochemical remission. The maximum diameter of the adenoma (B = - 0.131, p < 0.001) was a negative correlation factor, while treatment duration (B = 0.034, p = 0.002) was a positive correlation factor for biochemical response to medication.

CONCLUSION

Male prolactinoma has a low biochemical remission rate when treated alone, but multitherapy can improve it even more. Surgery may also be considered for male prolactinoma with a micro, and noninvasive tumor after a thorough evaluation.

Federal State Budgetary Educational Institution of Higher Education «Ryazan State Medical University named after Academician I. P. Pavlov» of the Ministry of Health of the Russian Federation, Fedotov IA, Shustov DI, Federal State Budgetary Educational Institution of Higher Education «Ryazan State Medical University named after Academician I. P. Pavlov» of the Ministry of Health of the Russian Federation, Petrov DS, Federal State Budgetary Educational Institution of Higher Education «Ryazan State Medical University named after Academician I. P. Pavlov» of the Ministry of Health of the Russian Federation, Radostina AA, Federal State Budgetary Educational Institution of Higher Education «Ryazan State Medical University named after Academician I. P. Pavlov» of the Ministry of Health of the Russian Federation, Volkova AA, Federal State Budgetary Educational Institution of Higher Education «Ryazan State Medical University named after Academician I. P. Pavlov» of the Ministry of Health of the Russian Federation. Impulse control disorders due to cocaine and synthetic stimulants use: a systematic review

The introduction of ICD-11 has opened up new horizons in understanding the impact of modern narcotic substances on mental health, in particular, it has increased the list of possible mental disorders associated with drug use. The purpose of the work is to conduct a systematic review of the literature and describe the features of the pathogenesis, clinical picture, and effectiveness of various types of therapy for impulse control disorders associated with use of cocaine and synthetic stimulants. A systematic analysis of scientific publications was performed in the eLibrary, PubMed, CNKI, and Google Scholar databases according to PRISMA recommendations. 41 publications were selected from the initially found 4,953 articles. The pathogenesis of induced impulse control disorders is associated with the direct effect of stimulant drugs on the brain and consists in the activation of D3 and 5‑HT1A receptors, as well as activation of limbic brain regions and a lack of inhibitory effects of the frontal lobe. Increased impulsivity in users of cocaine and synthetic stimulants has been proven in a large number of neurophysiological and neuroimaging studies. The frequency of occurrence, clinical features, and approaches to therapy of impulse control disorders resulting from the use of drugs with dopaminergic action (drugs for the treatment of Parkinson's disease and hyperprolactinemia, third-generation antipsychotics, and venlafaxine in high doses) have been described in details. At the same time, there is indirect evidence that cocaine and synthetic stimulants should cause impulse control disorders, since they have similar neurotransmitter activity. In addition, there are descriptions of the predominance of individual symptoms of impulse control disorders in this group of drug users. However, at the time of the review, no detailed description of these drug-induced disorders has been found. These are the prospects for further research. The use of fluoxetine and oxcarbazepine (for intermittent explosive disorder) and naltrexone (for kleptomania), as well as comprehensive prevention of drug use relapse and psychotherapy, has the highest degree of evidence as a therapy for impulse control disorders.

Impulse Control Disorders in Patients with Pituitary Tumors Treated with Dopamine Agonists: A Systematic Review

BACKGROUND

The increased prevalence of Impulse Control Disorders (ICDs) in dopamine agonist (DA) treated patients with Parkinson's disease is well described. Despite the frequent use of DAs in the management of pituitary tumors, the relationship between DAs and prevalence of ICDs in patients with pituitary tumours is unclear.

AIMS

To establish the prevalence of ICDs in patients with prolactinoma or acromegaly and determine whether prevalence differs in those on DAs to those treated without.

METHODS

Systematic review of the literature (registered a priori) reporting prevalence of ICDs in patients with prolactinoma or acromegaly (conducted June 2023). A narrative synthesis describing prevalence of ICDs according to assessment method was performed. Prevalence comparisons between patients with prolactinoma or acromegaly treated with DAs, to patients treated without, were summarised.

RESULTS

Studies were largely retrospective, observational and heterogenous, with few patients with prolactinoma and acromegaly treated without DA. Prevalence of ICDs varied between 0-60% in patients with prolactinoma, and from 5-23% in studies with at least five patients with acromegaly. In most studies comparing DA exposed to non-DA exposed cases, DA use was not associated with ICDs.

CONCLUSIONS

Reported prevalence of ICDs in patients with prolactinoma and acromegaly varies considerably. Given ICDs were reported to be highly prevalent in some studies, clinicians should be mindful of these potentially serious disorders. ICD screening tools validated for use in patients with pituitary tumors combined with prospective studies including appropriate controls, are necessary to accurately establish prevalence of ICDs and true impact of DAs in their development.

Prolactin in Polycystic Ovary Syndrome: Metabolic Effects and Therapeutic Prospects

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine and metabolic disorder in premenopausal women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Patients frequently present comorbidities, including obesity, insulin resistance, and impaired glucose and lipid metabolism. The diverse clinical presentation may mimic various endocrine disorders, making the diagnosis challenging in some clinical circumstances. Prolactin (PRL) is a recommended biomarker in the initial diagnostic workup to rule out hyperprolactinemia (HPRL). The traditional role of PRL is linked to lactation and the reproductive system. Recent research highlights PRL's emerging role in metabolic homeostasis. PRL influences metabolism directly by interacting with the pancreas, liver, hypothalamus, and adipose tissue. Its influence on an individual's metabolism is intricately tied to its serum concentration. While deficient and very high levels of PRL can negatively affect metabolism, intermediate-normal to moderately high levels may promote metabolic health. In women with PCOS, PRL levels may be altered. Research results on different aspects of the relationship between PCOS and the impact of various levels of PRL on metabolic homeostasis are limited and inconsistent. In this narrative literature review, we comprehensively examined data on serum PRL levels in PCOS patients. We investigated the correlation between a favorable metabolic profile and serum PRL levels in this population. Furthermore, we explored the concept of beneficial PRL effects on metabolism and discussed the potential therapeutic application of dopamine agonists in PCOS treatment. Lastly, we emphasized several promising avenues for future research in this field.

Current and Perspective Approaches to the Treatment of Prolactinomas

Background

Along with the presence of the 2011 Endocrine Society Clinical Practice Guidelines and numerous large-scale studies on the treatment of hyperprolactinemia of different origin, there are some unresolved questions, ambiguous and sometimes contradictory points of view regarding the management of patients with prolactinomas. This overview is devoted to the analysis of the results of modern clinical studies and the approaches towards the management of hyperprolactinemia caused by prolactinoma.

Materials and methods

A systematic research of the literature for the appropriate keywords published mainly for the last 10 years was done; also, a reference list of each selected article was analysed. We included to our review the articles reporting controversial issues or new data on the treatment of hyperprolactinemia.

Results

The review describes various problems arising during the treatment of prolactinoma. The presence of primary and secondary dopamine agonist resistance in each case requires an individual approach, and sometimes may include the use of the antineoplastic agent t emozolomide. The side effects of dopamine agonists are discussed, with quite rare ones, including valvulopathy, pathological psychological conditions and cerebrospinal rhinorrhea. The controversial issue of the duration and doses of the drug used to achieve a lasting effect in the treatment of prolactinomas is considered. There are some points connected with the frequency of relapses. Thus, recurrence is correlated to the duration of treatment with dopamine agonists, prolactin levels at diagnosis, and the initial tumor size. Metformin, somatostatin analogues, selective estrogen receptor modulators, tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, epidermal growth factor receptor antagonists are investigated nowadays as potential alternative methods of drug treatment of prolactinomas.

Conclusion

Drug therapy with dopamine agonists makes it possible to achieve the desired results in the vast majority of patients. However, despite the proven safety of this group of medicines, the risk of side effects should still be taken into account. The therapy regimen should be determined by the clinical course of prolactinoma and the patient's response to treatment. Other options of treatment should be considered in patients intolerant to medical therapy, with contraindication or resistance to dopamine agonists, in the case of a malignant tumor. The presence of refractory to any of the applied methods of treatment and aggressive prolactinomas leads to the search for new drugs.

Impulse control disorders in hyperprolactinemic patients on dopamine agonist therapy

Dopamine agonists (DAs) represent a mainstay of therapy for hyperprolactinemia and prolactinomas. The widespread use of DAs, including bromocriptine, cabergoline and (in some countries) quinagolide, has led to the emergence and recognition of impulse control disorders (ICDs) that may occur in association with DA therapy.Such ICDs include pathological gambling, compulsive shopping, hypersexuality and punding (the performance of repetitive tasks), among others. These manifestations can lead to substantial harms to patients and their families, if left undiagnosed and untreated. Several risk factors that may increase the risk of ICDs have been proposed, including younger age, male gender, smoking and alcohol use and history of depression.The diagnosis of ICDs in hyperprolactinemic patients treated with DAs requires a high index of suspicion and a systematic approach, using available screening questionnaires. However, it should be noted that available test instruments, including questionnaires and computerized tasks, have not been validated specifically in hyperprolactinemic patients. Hyperprolactinemic patients who develop ICDs should be withdrawn from DA therapy or, at a minimum, undergo a DA dose reduction, and considered for psychiatric consultation and cognitive behavioral therapy. However, the role of psychopharmacotherapy in hyperprolactinemic patients with ICDs remains incompletely characterized.Patient counseling regarding the risk of ICDs occurring in association with DA therapy, early detection and prompt intervention may mitigate potential harms associated with ICDs. Additional studies are needed to fully characterize risk factors, underlying mechanisms and identify effective therapies for ICDs in patients with hyperprolactinemia receiving DAs.

Coenzyme Q10 improves ovarian histology and attenuates the expression of angiogenesis-associated proteins in the ovary of rats with experimental hyperstimulation syndrome

OBJECTIVES

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication characterized by many side effects. Coenzyme Q10 (CoQ10) is a protective lipophilic molecule with an extensive range of biological functions, but its possible protective effect on the ovary in OHSS has not as yet been studied. The present study aimed to investigate the potential protective effects of CoQ10 on ovarian histological and molecular alterations in an experimental model of OHSS in rats.

MATERIALS AND METHODS

Thirty female (2 months old) Wistar rats were randomly divided into 6 equal groups: control, OHSS, OHSS+CoQ10 (OHSS+ 200 mg/kg CoQ10 for 10 days), OHSS+ cabergoline (CAB) (OHSS+ 100 µg/kg CAB for 6 days), and CoQ10 and CAB (rats receiving similar doses to treatment groups.( In the end, the effects of treatments were assessed by measuring expressions of vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) in the ovary via western blotting, ovarian histomorphological alterations assessments, and serum estradiol and progesterone levels via ELISA.

RESULTS

There were histological alterations in OHSS groups, including the elevation of diameter and numbers of the corpus luteum and atretic follicles, and decreasing follicular reserve count, hyperemia, and hemorrhage at ovarian stroma. Treatment of OHSS groups with CAB and CoQ10 could decrease histological changes, serum estrogen and progesterone, and overexpression of VEGF and COX-2 proteins.

CONCLUSION

Our results showed that ovarian histological and molecular alterations observed in experimental OHSS can be ameliorated by administration of CoQ10, indicating that CoQ10 can be used as new supportive care for OHSS patients.