Efficacy and safety of dopamine agonists in patients treated with antipsychotics and presenting a macroprolactinoma
| Autor: | Carine Courtillot, Marie Laure Nunes, Jérôme Bertherat, Philippe Caron, Lucie Allard, Walid Choucha, Christel Jublanc, C. Cortet, Frédérique Albarel, Philippe Chanson, Dominique Maiter, Brigitte Delemer, Emmanuelle Corruble, Sylvie Salenave, Julie Sarfati, Gérald Raverot |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Psychosis Exacerbation Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism Context (language use) 03 medical and health sciences 0302 clinical medicine Endocrinology Belgium Recurrence Internal medicine medicine Humans Drug Interactions Pituitary Neoplasms Prolactinoma Macroprolactinoma Antipsychotic Retrospective Studies business.industry Mental Disorders Retrospective cohort study General Medicine Middle Aged medicine.disease Prolactin Psychotic Disorders 030220 oncology & carcinogenesis Dopamine Agonists Female France Headaches medicine.symptom business Antipsychotic Agents |
| Zdroj: | European journal of endocrinology. 183(2) |
| ISSN: | 1479-683X |
| Popis: | Context In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge. Objective Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics. Design This was a multicenter (France and Belgium) retrospective study. Patients Eighteen patients treated with antipsychotics were included. Results Under DA, median PRL levels decreased from 1247 (117–81 132) to 42 (4–573) ng/mL (P = 0.008), from 3850 (449–38 000) to 141 (60–6000) ng/mL (P = 0.037) and from 1664 (94–9400) to 1215 (48–5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0–57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions. Conclusion Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics. |
| Databáze: | OpenAIRE |
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