De Sousa Sunita M C, Chapman Ian M, Falhammar Henrik, Torpy David J
Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia.
SA Clinical Genetics Service, Women's and Children's Hospital, Adelaide, Australia.
Endocrine. 2017 Feb;55(2):618-624. doi: 10.1007/s12020-016-1088-1. Epub 2016 Sep 6.
Dopamine agonists are the first line of therapy for prolactinomas, with high rates of biochemical control and tumour shrinkage. Toxicity is considered to be low and manageable by switching of agents and dose reduction. Dopamine agonist-induced impulse control disorders are well described in the neurology setting, but further data are required regarding this toxicity in prolactinoma patients. We performed a multicenter retrospective cohort study of eight men with prolactinomas and associated central hypogonadism. The eight men had no prior history of psychiatric disease, but each developed disruptive hypersexuality whilst on dopamine agonist therapy at various doses. Cabergoline, bromocriptine and quinagolide were all implicated. Hypersexuality had manifold consequences, including relationship discord, financial loss, reduced work performance, and illicit activity. We hypothesise that this phenomenon is due to synergy between reward pathway stimulation by dopamine agonists, together with rapid restoration of the eugonadal state after prolonged hypogonadism. We refer here to this distinct drug toxicity as 'dopa-testotoxicosis'. Given the profound impact in these patients and their families, cessation of dopamine agonists should be considered in men who develop hypersexuality, and pituitary surgery may be required to facilitate this. Awareness of this distinct impulse control disorder should enable further research into the prevalence, natural history and management of dopa-testotoxicosis. The condition is likely under-reported due to the highly personal nature of the symptoms and we suggest a simple written questionnaire to screen for hypersexuality and other behavioural symptoms within the first six months of dopamine agonist treatment.
多巴胺激动剂是泌乳素瘤的一线治疗药物，生化控制率和肿瘤缩小率较高。其毒性被认为较低，可通过更换药物和减少剂量来控制。多巴胺激动剂诱发的冲动控制障碍在神经病学领域已有充分描述，但关于泌乳素瘤患者的这种毒性还需要更多数据。我们对8名患有泌乳素瘤及相关中枢性性腺功能减退的男性进行了一项多中心回顾性队列研究。这8名男性既往无精神疾病史，但在接受不同剂量多巴胺激动剂治疗时均出现了破坏性的性欲亢进。卡麦角林、溴隐亭和喹高利特均与之有关。性欲亢进产生了多方面的后果，包括关系不和、经济损失、工作表现下降和非法活动。我们推测这种现象是由于多巴胺激动剂对奖赏通路的刺激，以及长期性腺功能减退后性腺功能正常状态的快速恢复之间的协同作用所致。我们在此将这种独特的药物毒性称为“多巴-促性腺激素毒性症（dopa-testotoxicosis）”。鉴于对这些患者及其家庭产生的深远影响，对于出现性欲亢进的男性应考虑停用多巴胺激动剂，可能需要垂体手术来促成此事。认识到这种独特的冲动控制障碍应能促进对多巴-促性腺激素毒性症的患病率、自然史和管理的进一步研究。由于症状具有高度隐私性，这种情况可能报告不足，我们建议在多巴胺激动剂治疗的前六个月内使用一份简单的书面问卷来筛查性欲亢进和其他行为症状。
