Assistance Publique Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Assistance Publique Hôpitaux de Marseille, Service Endocrinologie, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Hôpital de la Conception, Marseille, France.
Eur J Endocrinol. 2020 Aug 1;183(2):221-231. doi: 10.1530/EJE-20-0125.
In patients treated with antipsychotics, the rare occurrence of a macroprolactinoma represents a therapeutic challenge.
Our aim was to evaluate the efficacy and psychiatric safety of dopamine agonists (DAs) prescribed for large macroprolactinomas in patients with psychosis treated with antipsychotics.
This was a multicenter (France and Belgium) retrospective study.
Eighteen patients treated with antipsychotics were included.
Under DA, median PRL levels decreased from 1247 (117-81 132) to 42 (4-573) ng/mL (P = 0.008), from 3850 (449-38 000) to 141 (60-6000) ng/mL (P = 0.037) and from 1664 (94-9400) to 1215 (48-5640) ng/mL (P = 0.56) when given alone (n = 8), before surgery (n = 7), or after surgery (n = 6), respectively. The prolactinoma median largest diameter decreased by 28% (0-57) in patients under DAs alone (P = 0.02) but did not change when given after surgery. Optic chiasm decompression was achieved in 82% of patients. Five patients (28%) were admitted for psychotic relapse while receiving DAs (but three of them had stopped antipsychotic treatment at that time). A more severe underlying psychosis, rather than the DA treatment itself, may explain such psychiatric admissions.
Even if the DA efficacy on PRL levels and tumor volume in patients with macroprolactinoma under antipsychotic drugs is less impressive than that typically observed, it may be considered satisfactory for half of our patients, particularly in cases of optic chiasm compression. Psychotic exacerbation was unusual in these patients, occurring mostly in those with the most severe psychotic forms. DAs may therefore be used as antitumor treatment for macroprolactinoma in patients with visual involvement, severe headaches or invasion into the skull base who receive antipsychotics.
在接受抗精神病药物治疗的患者中，罕见的大型泌乳素瘤代表了一种治疗挑战。
我们旨在评估多巴胺激动剂（DA）治疗抗精神病药物治疗的精神病患者中大型泌乳素瘤的疗效和精神安全性。
这是一项多中心（法国和比利时）回顾性研究。
纳入了 18 名接受抗精神病药物治疗的患者。
在 DA 治疗下，PRL 水平中位数从 1247（117-81132）降至 42（4-573）ng/ml（P=0.008），从 3850（449-38000）降至 141（60-6000）ng/ml（P=0.037）和 1664（94-9400）至 1215（48-5640）ng/ml（P=0.56），分别为单独使用时（n=8）、手术前（n=7）或手术后（n=6）。单独使用 DA 治疗的患者中，泌乳素瘤最大直径中位数缩小了 28%（0-57）（P=0.02），但手术后使用时无变化。视交叉减压在 82%的患者中实现。5 名患者（28%）在接受 DA 治疗时因精神病复发而入院（但其中 3 名当时已停止抗精神病药物治疗）。更严重的潜在精神病，而不是 DA 治疗本身，可能解释了这种精神科住院的原因。
即使在接受抗精神病药物治疗的患者中，DA 对泌乳素瘤的疗效和肿瘤体积的影响不如通常观察到的那么显著，但对我们一半的患者来说，可能仍然令人满意，特别是对视交叉受压的患者。在这些患者中，精神病恶化并不常见，主要发生在最严重的精神病形式的患者中。因此，对于接受抗精神病药物治疗且存在视觉受累、严重头痛或侵犯颅底的患者，DA 可作为治疗大型泌乳素瘤的抗肿瘤药物。
