Penchev Plamen, Milanova-Ilieva Daniela, Gaydarski Lyubomir, Husain Noor, Chenkov Yavor, Petrov Petar-Preslav, Kirovakov Zlatko, Stanchev Pavel
Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
Department of Pediatrics, University Hospital "St. George", Plovdiv, Bulgaria.
J Clin Neurosci. 2025 Aug;138:111363. doi: 10.1016/j.jocn.2025.111363. Epub 2025 Jun 5.
Dopamine agonists (DAs) are the first-line treatment for prolactinoma; however, long-term use has been linked to psychiatric complications, particularly impulse control disorders (ICDs). While ICDs are well-documented in Parkinson's disease patients receiving DAs, data on prolactinoma patients remain limited. This systematic review and meta-analysis aimed to assess the prevalence of ICDs among prolactinoma patients treated with DAs.
A systematic search was conducted in PubMed, Cochrane, and Scopus for studies evaluating ICD prevalence in prolactinoma patients receiving DAs. Statistical analysis was performed using R 4.3.1 and RevMan 5.4.1. Heterogeneity was assessed using the I statistic and the Cochrane Q test, and risk ratios (RR) were calculated using a random-effects model.
Eight studies, comprising 858 patients, were included. Among these, 483 (56 %) (mean 39 years, mean 57 % females) were treated with DAs. DA therapy was associated with a higher prevalence of ICDs (RR 1.71; 95 % CI [1.29; 2.27]; p = 0.0002; I = 29 %), particularly hypersexuality (RR 2.61; 95 % CI [1.65; 4.12]; p = 0.0001; I = 0 %) and punding (RR 2.31; 95 % CI [1.32-4.03]; p = 0.003; I = 0 %). Hypersexuality was notably more prevalent in men (RR 1.10; 95 % CI [0.75; 1.61]; p = 0.0342; I = 0 %). No significant differences were observed in pathological gambling, binge eating, or compulsive shopping.
DAs may be associated with increased risk of ICDs in prolactinoma patients, particularly hypersexuality and punding, highlighting the need for routine screening during DA therapy. However, no statistically significant differences were found between groups regarding pathological gambling, binge eating, and compulsive shopping. Given the observational nature of the included studies, these associations should be interpreted with caution.
多巴胺激动剂（DAs）是泌乳素瘤的一线治疗药物；然而，长期使用与精神并发症有关，尤其是冲动控制障碍（ICDs）。虽然在接受多巴胺激动剂治疗的帕金森病患者中，冲动控制障碍已有充分记录，但泌乳素瘤患者的数据仍然有限。本系统评价和荟萃分析旨在评估接受多巴胺激动剂治疗的泌乳素瘤患者中冲动控制障碍的患病率。
在PubMed、Cochrane和Scopus中进行系统检索，以查找评估接受多巴胺激动剂治疗的泌乳素瘤患者冲动控制障碍患病率的研究。使用R 4.3.1和RevMan 5.4.1进行统计分析。使用I统计量和Cochrane Q检验评估异质性，并使用随机效应模型计算风险比（RR）。
纳入了八项研究，共858名患者。其中，483名（56%）（平均年龄39岁，女性平均占57%）接受了多巴胺激动剂治疗。多巴胺激动剂治疗与冲动控制障碍的较高患病率相关（RR 1.71；95% CI [1.29；2.27]；p = 0.0002；I = 29%），尤其是性欲亢进（RR 2.61；95% CI [1.65；4.12]；p = 0.0001；I = 0%）和刻板动作（RR 2.31；95% CI [1.32 - 4.03]；p = 0.003；I = 0%）。性欲亢进在男性中尤为普遍（RR 1.10；95% CI [0.75；1.61]；p = 0.0342；I = 0%）。在病理性赌博、暴饮暴食或强迫购物方面未观察到显著差异。
多巴胺激动剂可能与泌乳素瘤患者冲动控制障碍风险增加有关，尤其是性欲亢进和刻板动作，这凸显了在多巴胺激动剂治疗期间进行常规筛查的必要性。然而，在病理性赌博、暴饮暴食和强迫购物方面，各组之间未发现统计学上的显著差异。鉴于纳入研究的观察性性质，这些关联应谨慎解释。
