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      SUN-444 Efficacy and Safety of Dopamine Agonists in Psychiatric Patients Treated with Antipsychotics and Presenting a Macroprolactinoma

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          Abstract

          Dopamine agonists (DAs), which are used as first line therapy in patients with macroprolactinomas, and antipsychotics have opposite effects on D2 dopamine receptors. In patients with severe psychiatric conditions treated with antipsychotics, the rare occurrence of a macroprolactinoma, particularly when it compresses the optic chiasm represents a therapeutic challenge. Indeed, on one hand, antipsychotics by their antagonistic effect on D2 receptors, could decrease or even abolish the effects of DAs on prolactinomas; on the other hand, DAs could make antipsychotics ineffective and lead to psychiatric exacerbation. Our retrospective study aimed at evaluating the efficacy and psychiatric safety of DAs prescribed for the treatment of large prolactin (PRL)-secreting macroadenomas in patients whose underlying psychiatric disorder necessitated treatment with antipsychotics. Endocrinological and psychiatric data on 18 patients were obtained from clinical charts collected in several Endocrinology centers in France and Belgium. Results are expressed as median value (interquartile range). Each of the 18 patient received DAs. Nine had also pituitary surgery (most often because of insufficient tumoral response) and two had radiotherapy. The median decrease of prolactin (PRL) levels, under DA, was -94.7 (30.6) % for the 8 patients treated with DAs only [from an initial median level of 1247 (13012) ng/ml to a minimal level of 42 (244) ng/ml, p=0.008], -85,5 (16,5) % for the 7 patients treated before surgery [3850 (8831) ng/ml to 141 (1510) ng/ml, p=0.03] and -18 (62,75)% for the 6 patients treated after surgery [1664 (1473) ng/ml to 1215 (3094) ng/ml, p=0.56]. The median decrease of prolactinoma largest diameter was -28 (23.5) % for patients only treated with DAs [from an initial median diameter of 27 (22.5) mm to 24 (11.75) mm after treatment; p=0.02] and it almost did not change in the patients who had surgery. Nevertheless, DA treatment allowed optic chiasm decompression in 82% of the patients. Five patients (28%) were admitted for psychiatric relapse while they were receiving DAs (but three of them had stopped their antipsychotic treatment at that time). Moreover, 89% of these patients had a history of one or more psychiatric admissions compared to 11% among those who did not have any relapse (p=0.0034). Even if DAs efficacy on PRL levels and tumoral volume in macroprolactinoma patients under antipsychotic drugs is less impressive than that observed usually, it may considered as satisfactory for half of our patients, particularly in case of optic chiasm compression. Psychiatric symptoms exacerbation was unusual in these patients, occurring mostly in those with the most severe psychiatric conditions. DAs may therefore be used as antitumoral treatment of macroprolactinoma in patients receiving antipsychotics.

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          Author and article information

          Journal
          J Endocr Soc
          J Endocr Soc
          jes
          Journal of the Endocrine Society
          Endocrine Society (Washington, DC )
          2472-1972
          15 April 2019
          30 April 2019
          : 3
          : Suppl 1 , ENDO 2019 Abstracts - 101st Annual Meeting of the Endocrine Society – March 23 – 26th, 2019 – New Orleans, Louisiana
          : SUN-444
          Affiliations
          [_1]Bordeaux University Hospital, Bordeaux, , France
          [_2]Dept of Endocrinology, CHU Larrey, Toulouse Cedex 9, , France
          [_3]DEPT OF ENDO, Clinique Marc Linquette, Lille, , France
          [_4]Dept of Endo & Nutrition, Cliniques Universitaires Saint-Luc UCL, Brussels, , Belgium
          [_5]Ser Endo-Diab, Hop Robert Debre, Reims, , France
          [_6]Hop Timone, Marseille, , France
          [_7]Dept of Endocrinology, Hopital Cochin, Paris, , France
          [_8]Hôpital Pitié Salpétrière, Paris, , France
          [_9]Hosp Bicetre, Le Kremlin-Bicetre, , France
          [_10]Serv Pr Chanson, Hosp Bicetre, Le Kremlin-Bicetre, , France
          [_11]Endocrinology and Reproductive Diseases, Hosp Saint-Antoine, Paris, , France
          [_12]Hospices Civils de Lyon, Lyon Cedex 03, , France
          Article
          js.2019-SUN-444
          10.1210/js.2019-SUN-444
          6552775
          3e700b02-d3a8-4e14-a263-7f5e9df2f507
          Copyright © 2019 Endocrine Society

          This article has been published under the terms of the Creative Commons Attribution Non-Commercial, No-Derivatives License (CC BY-NC-ND; https://creativecommons.org/licenses/by-nc-nd/4.0/).

          History
          Categories
          Neuroendocrinology and Pituitary
          Neuroendocrinology and Pituitary

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