Athanasoulia-Kaspar Anastasia P, Popp Kathrin H, Stalla Gunter Karl
Max Planck Institute of PsychiatryDepartment of Internal Medicine, Endocrinology and Clinical Chemistry, Munich, Germany
Max Planck Institute of PsychiatryDepartment of Internal Medicine, Endocrinology and Clinical Chemistry, Munich, Germany.
Endocr Connect. 2018 Feb;7(2):R88-R94. doi: 10.1530/EC-18-0030. Epub 2018 Jan 29.
The dopaminergic treatment represents the primary treatment in prolactinomas, which are the most common pituitary adenomas and account for about 40% of all pituitary tumours with an annual incidence of six to ten cases per million population. The dopaminergic treatment includes ergot and non-ergot derivatives with high affinity for the dopamine receptors D1 or/and D2. Through the activation of the dopaminergic pathway on pituitary lactotrophs, the dopamine agonists inhibit the prolactin synthesis and secretion, therefore normalizing the prolactin levels and restoring eugonadism, but they also lead to tumour shrinkage. Treatment with dopamine agonists has been associated - apart from the common side effects such as gastrointestinal symptoms, dizziness and hypotension - with neuropsychiatric side effects such as impulse control disorders (e.g. pathological gambling, compulsive shopping, hypersexuality and binge eating) and also with behavioral changes from low mood, irritability and verbal aggressiveness up to psychotic and manic symptoms and paranoid delusions not only in patients with prolactinomas but also in patients with Parkinson's disease and restless leg syndrome. They usually have de novo onset after initiation of the dopaminergic treatment and have been mainly reported in patients with Parkinson's disease, who are being treated with higher doses of dopamine agonists. Moreover, dopamine and prolactin seem to play an essential role in the metabolic pathway. Patients with hyperprolactinemia tend to have increased body weight and an altered metabolic profile with hyperinsulinemia and increased prevalence of diabetes mellitus in comparison to healthy individuals and patients with non-functioning pituitary adenomas. Treatment with dopamine agonists in these patients in short-term studies seems to lead to weight loss and amelioration of the metabolic changes. Together these observations provide evidence that dopamine and prolactin have a crucial role both in the regard and metabolic system, findings that merit further investigation in long-term studies.
多巴胺能治疗是泌乳素瘤的主要治疗方法，泌乳素瘤是最常见的垂体腺瘤，约占所有垂体肿瘤的40%，每年发病率为每百万人口6至10例。多巴胺能治疗包括对多巴胺受体D1或/和D2具有高亲和力的麦角和非麦角衍生物。通过激活垂体催乳细胞上的多巴胺能途径，多巴胺激动剂抑制泌乳素的合成和分泌，从而使泌乳素水平正常化并恢复性腺功能正常，但它们也会导致肿瘤缩小。除了常见的副作用如胃肠道症状、头晕和低血压外，多巴胺激动剂治疗还与神经精神副作用有关，如冲动控制障碍（如病理性赌博、强迫性购物、性欲亢进和暴饮暴食），也与行为改变有关，从情绪低落、易怒和言语攻击性到精神病和躁狂症状以及偏执妄想，不仅在泌乳素瘤患者中出现，在帕金森病和不安腿综合征患者中也有出现。它们通常在多巴胺能治疗开始后新发，主要在接受高剂量多巴胺激动剂治疗的帕金森病患者中报道。此外，多巴胺和泌乳素似乎在代谢途径中起重要作用。与健康个体和无功能性垂体腺瘤患者相比，高泌乳素血症患者往往体重增加，代谢谱改变，伴有高胰岛素血症，糖尿病患病率增加。短期研究中，这些患者使用多巴胺激动剂治疗似乎会导致体重减轻和代谢变化改善。这些观察结果共同提供了证据，表明多巴胺和泌乳素在生殖和代谢系统中都起着关键作用，这些发现值得在长期研究中进一步探讨。
