Prolactin-secreting pituitary adenoma in neuroleptic treated patients with psychotic disorder.
Three patients with psychoses and concomitant prolactin-secreting pituitary tumours are described. Patients A and B had bipolar and schizoaffective disorders, respectively. They had both been treated with neuroleptics for 20 years before the prolactinomas were revealed. Patient C developed a paranoid psychosis after two years of continuous bromocriptine treatment for a pituitary tumour. In patient A the prolactin level was successfully normalized and a good antipsychotic effect was maintained by combined therapy with haloperidol and quinagolide but not bromocriptine. In patient B the prolactinoma was removed by surgery, in view of the serious nature of the psychotic disorder, to avoid psychotic relapse by treatment with a dopamine agonist. In patient C a good result was obtained with the combination of clozapine and bromocriptine. These case reports support the view that neuroleptics being dopamine antagonists and dopamine agonistic agents which are the primary treatment of prolactinomas can cancel out each other's effects. The combination of clozapine and quinagolide is recommended as the treatment of choice for most patients.
Melkersson
K
K
Department of Psychiatry, SZ, Görans Hospital, Stockholm, Sweden.
Hulting
A L
AL
D000328:Adult; D000634:Aminoquinolines / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000453:epidemiology; D001971:Bromocriptine / Q000009:adverse effects / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D015897:Comorbidity; D018491:Dopamine Agonists / Q000627:therapeutic use*; D018492:Dopamine Antagonists / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011605:Psychoses, Substance-Induced / Q000188:drug therapy / Q000209:etiology; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
D000634:Aminoquinolines; D014150:Antipsychotic Agents; D018491:Dopamine Agonists; D018492:Dopamine Antagonists; D001971:Bromocriptine; C046650:quinagolide; D011388:Prolactin; D003024:Clozapine