Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas
Prolactinomas are the most common hypersecretory pituitary adenoma. The traditional first-line therapy is dopamine agonists (DAs), which are highly effective and tolerated in the majority of cases. However, DAs have the potential for psychiatric complications, such as psychosis, impulse control diso...
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Bioscientifica
2025-01-01
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| Series: | Endocrine Oncology |
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| Online Access: | https://eo.bioscientifica.com/view/journals/eo/5/1/EO-24-0065.xml |
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| author | Edward Mignone Alistair K Jukes Rowan Valentine Richard Allison Sunita M C De Sousa |
| author_facet | Edward Mignone Alistair K Jukes Rowan Valentine Richard Allison Sunita M C De Sousa |
| author_sort | Edward Mignone |
| collection | DOAJ |
| description | Prolactinomas are the most common hypersecretory pituitary adenoma. The traditional first-line therapy is dopamine agonists (DAs), which are highly effective and tolerated in the majority of cases. However, DAs have the potential for psychiatric complications, such as psychosis, impulse control disorders and anxiety/depression. It has been repeatedly suggested that aripiprazole may be considered in individuals with a psychiatric disorder and prolactinoma, potentially enabling DA dose reduction or even cessation. We report the first case of aripiprazole competing with cabergoline and reducing its efficacy in the treatment of a giant prolactinoma, as evidenced by an immediate and marked rise in serum prolactin (approximately 350% increase over 5 weeks) despite stable cabergoline dosing. We also present a systematic review of aripiprazole use in prolactinomas, showing that aripiprazole monotherapy effectively reduces serum prolactin and concurrently commenced aripiprazole/DA dual therapy may still permit prolactin lowering, although there were no previous cases where aripiprazole was added to an established DA therapy to indicate the direct effect of aripiprazole on DA efficacy. Based on our case, we support close monitoring of individuals with prolactinomas on dual aripiprazole/DA therapy and recommend against the addition of aripiprazole to DA therapy where timely prolactinoma treatment is essential (e.g. aggressive prolactinomas and those associated with compressive effects). |
| format | Article |
| id | doaj-art-c89a2c5ec86d42fbaaa67447bbe468d1 |
| institution | Kabale University |
| issn | 2634-4793 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Bioscientifica |
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| series | Endocrine Oncology |
| spelling | doaj-art-c89a2c5ec86d42fbaaa67447bbe468d12025-01-12T04:28:27ZengBioscientificaEndocrine Oncology2634-47932025-01-015110.1530/EO-24-00651Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomasEdward Mignone0Alistair K Jukes1Rowan Valentine2Richard Allison3Sunita M C De Sousa4Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, AustraliaDepartment of Neurosurgery, Royal Adelaide Hospital, Adelaide, AustraliaDepartment of Otorhinolaryngology, Queen Elizabeth Hospital, Woodville, South Australia, AustraliaSchool of Medicine, University of Adelaide, Adelaide, South Australia, AustraliaEndocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, AustraliaProlactinomas are the most common hypersecretory pituitary adenoma. The traditional first-line therapy is dopamine agonists (DAs), which are highly effective and tolerated in the majority of cases. However, DAs have the potential for psychiatric complications, such as psychosis, impulse control disorders and anxiety/depression. It has been repeatedly suggested that aripiprazole may be considered in individuals with a psychiatric disorder and prolactinoma, potentially enabling DA dose reduction or even cessation. We report the first case of aripiprazole competing with cabergoline and reducing its efficacy in the treatment of a giant prolactinoma, as evidenced by an immediate and marked rise in serum prolactin (approximately 350% increase over 5 weeks) despite stable cabergoline dosing. We also present a systematic review of aripiprazole use in prolactinomas, showing that aripiprazole monotherapy effectively reduces serum prolactin and concurrently commenced aripiprazole/DA dual therapy may still permit prolactin lowering, although there were no previous cases where aripiprazole was added to an established DA therapy to indicate the direct effect of aripiprazole on DA efficacy. Based on our case, we support close monitoring of individuals with prolactinomas on dual aripiprazole/DA therapy and recommend against the addition of aripiprazole to DA therapy where timely prolactinoma treatment is essential (e.g. aggressive prolactinomas and those associated with compressive effects).https://eo.bioscientifica.com/view/journals/eo/5/1/EO-24-0065.xmlaripiprazoleprolactinomacabergolineneuroendocrinology |
| spellingShingle | Edward Mignone Alistair K Jukes Rowan Valentine Richard Allison Sunita M C De Sousa Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas Endocrine Oncology aripiprazole prolactinoma cabergoline neuroendocrinology |
| title | Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas |
| title_full | Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas |
| title_fullStr | Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas |
| title_full_unstemmed | Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas |
| title_short | Aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas |
| title_sort | aripiprazole use as a cause of dopamine agonist failure in the treatment of prolactinomas |
| topic | aripiprazole prolactinoma cabergoline neuroendocrinology |
| url | https://eo.bioscientifica.com/view/journals/eo/5/1/EO-24-0065.xml |
| work_keys_str_mv | AT edwardmignone aripiprazoleuseasacauseofdopamineagonistfailureinthetreatmentofprolactinomas AT alistairkjukes aripiprazoleuseasacauseofdopamineagonistfailureinthetreatmentofprolactinomas AT rowanvalentine aripiprazoleuseasacauseofdopamineagonistfailureinthetreatmentofprolactinomas AT richardallison aripiprazoleuseasacauseofdopamineagonistfailureinthetreatmentofprolactinomas AT sunitamcdesousa aripiprazoleuseasacauseofdopamineagonistfailureinthetreatmentofprolactinomas |