Calva-González Metztli, Villanueva-Solórzano Pedro Leonardo, Crail-Meléndez Edgar D, Loya-Murguia Kennya M, Dehesa Hernandez Itzel Ariadna, Robles-Ramirez Fernando, Rodríguez-Hernández Luis A, Mondragón-Soto Michel G, Flores-Vázquez José Guillermo, Portocarrero-Ortiz Lesly A
Psychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX.
Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX.
Cureus. 2023 Jun 2;15(6):e39869. doi: 10.7759/cureus.39869. eCollection 2023 Jun.
Background and objective Invasive prolactinoma accounts for 1-5% of all prolactinomas. Its mass and compromise of the diencephalon and frontal and temporal lobes may result in a range of neuropsychiatric symptoms that are often missed during initial evaluations. Cabergoline is a dopaminergic agonist used as the first-line treatment for these patients; however, its effect on neuropsychiatric symptoms in this particular setting remains unexplored. In this study, our primary objective was to describe the epidemiology of neuropsychiatric comorbidities in Mexican patients with invasive prolactinomas. The secondary aim of the study was to describe how these comorbidities are modified by treatment with cabergoline, through follow-up with standardized clinical scales. Methods This was a retrospective analytic study. Data were pulled from clinical records and evaluations of patients at baseline and at six-month follow-ups. Results A total of 10 patients were included in the study. None of them had any prior psychiatric diagnosis. At the initial evaluation, 70% were diagnosed with depression or anxiety. During follow-up, two patients developed neuropsychiatric symptoms; there was a significant reduction in tumor size but no difference was found in clinimetric scores for neuropsychiatric comorbidities. Conclusions Patients with giant prolactinomas may present with several neuropsychiatric symptoms throughout the course of their disease. Although there are several mechanisms involved, it is important to keep in mind that cabergoline may interfere with the dopaminergic pathways involved. This study was underpowered to determine the association but can serve as a pilot for further research on this topic.
背景与目的 侵袭性泌乳素瘤占所有泌乳素瘤的1% - 5%。其肿块以及对视丘下部、额叶和颞叶的压迫可能导致一系列神经精神症状，而这些症状在初始评估时常常被漏诊。卡麦角林是一种多巴胺能激动剂，用作这些患者的一线治疗药物；然而，其在这种特定情况下对神经精神症状的影响仍未得到探究。在本研究中，我们的主要目的是描述墨西哥侵袭性泌乳素瘤患者神经精神共病的流行病学情况。该研究的次要目的是通过使用标准化临床量表进行随访，描述卡麦角林治疗如何改变这些共病情况。方法 这是一项回顾性分析研究。数据取自患者基线及六个月随访时的临床记录和评估。结果 本研究共纳入10例患者。他们均无既往精神疾病诊断。在初始评估时，70%的患者被诊断为抑郁或焦虑。在随访期间，有2例患者出现神经精神症状；肿瘤大小显著减小，但神经精神共病的临床评分未见差异。结论 巨大泌乳素瘤患者在疾病过程中可能出现多种神经精神症状。尽管涉及多种机制，但需牢记卡麦角林可能会干扰相关的多巴胺能通路。本研究的样本量不足以确定两者之间的关联，但可作为该主题进一步研究的先导。
