Treatment of Prolactinoma in a Patient with an Underlying Psychiatric Disorder
Prolactinoma management is substantially more complex when the patient has a co-existing psychiatric disorder, particularly when antipsychotic therapy is in use. This scenario requires careful, multidisciplinary decision-making.
Clinical Scenario
Prolactinoma in a patient with an underlying psychiatric disorder, typically receiving antipsychotic treatment. Management of this population requires collaboration between the endocrinologist, neurosurgeon, and psychiatrist. Initiation of dopamine agonist treatment in patients with an underlying psychiatric illness is probably safe but requires caution and psychiatric consultation.
Treatment Approach
Management centres on dopamine agonist therapy — generally at higher doses than those used in patients not receiving antipsychotics. The complete evidence-based regimen and decision algorithm are available in the full protocol.
Treatment Goals
Biochemical control (reduction in serum prolactin levels), reduction in adenoma size, and improvement in visual fields.
References
DOI: 10.1038/s41574-023-00886-5
- Management of prolactinoma in patients with an underlying psychiatric disorder requires collaboration between the endocrinologist, neurosurgeon and psychiatrist (strong).
- Initiation of dopamine agonist treatment in patients with an underlying psychiatric illness is probably safe but requires caution and psychiatric consultation (weak).
- Dopamine agonist treatment is effective to treat prolactinoma in patients receiving antipsychotics, with higher dopamine agonist doses than normally used required to achieve biochemical control and reduce adenoma size, although improvement in visual fields occurs in most patients prescribed first-line dopamine agonist therapy.