目的:催乳素瘤-垂体肿瘤过度产生催乳素-可引起各种麻烦的症状。多巴胺激动剂(DAs)减少催乳素途径中催乳素的产生,使它们成为泌乳素瘤的一线治疗方法。然而,DA治疗的主要副作用,高多巴胺痛,是精神病副作用的明确病因。精神病通常用多巴胺拮抗剂治疗,可以诱发高催乳素血症.这对既有泌乳素瘤又有精神病的患者提出了挑战。因为一种情况的治疗可能会使另一种情况恶化。这篇综述旨在为患有催乳素瘤和精神症状的患者确定适当的治疗方案。
方法:这篇综述研究了1960年至2023年以英文发表并涉及人类受试者的PubMed引文。病例报告,案例系列,以及涉及伴有泌乳素腺瘤和精神症状的患者的队列研究,正如大脑成像所证实的,血清催乳素水平,以及精神病症状的病史或图表报告,包括在内。
结果:主题分析包括23份报告,涉及42名参与者;42名患者中有27名经历了催乳素水平和精神症状的显著降低(64%)。这42例患者的治疗包括停止或改变抗精神病药/多巴胺拮抗剂治疗或停止DA治疗以减轻精神症状。将手术或放疗后药物治疗作为最后一线策略。然而,在某些情况下(见表2至表4),尽管进行了调整,但精神或催乳素相关症状仍复发。
结论:临床医生可能会发现优先考虑特定的抗精神病药(阿立哌唑,奥氮平,齐拉西酮,或氯氮平)比其他(利培酮,硫利达嗪,硫代噻吩,和remoxibrey)。建议至少定期停用DA药物,直至患者病情好转。如果这两种初始方法在症状管理方面没有显著改善,可以考虑手术或放射治疗。由于患者对这些疗法的反应可能不同,我们的研究仍建议采用以患者为中心的方法.
OBJECTIVE: Prolactinomas-pituitary tumors that overproduce prolactin-can cause various troublesome symptoms. Dopamine agonists (DAs) reduce prolactin production in the prolactin pathway, making them the first-line treatment for prolactinomas. However, the main side effect of DA treatment, hyperdopaminergia, is an explicit etiology for psychiatric side effects. Psychiatric conditions are often treated with dopamine antagonists, which can induce hyperprolactinemia. This presents a challenge for patients with both a
prolactinoma and a preexisting psychiatric condition, as treatment of one condition could worsen the other. This review seeks to identify an adequate therapeutic regimen for patients with coexisting prolactinomas and psychiatric symptoms.
METHODS: This review examined PubMed citations from 1960 to 2023 published in English and involving human subjects. Case reports, case series, and cohort studies involving patients with concomitant prolactinomas and psychiatric symptoms, as validated by brain imaging, serologic prolactin levels, and medical history or chart reports of psychiatric symptoms, were included.
RESULTS: Thematic analysis included 23 reports involving 42 participants; 27 of the 42 patients experienced a significant reduction in prolactin levels and psychiatric symptoms (64%). Treatment of those 42 patients included discontinuing or altering antipsychotic/dopamine antagonist therapy or discontinuing DA therapy to reduce psychiatric symptoms, with surgery or radiation postpharmacotherapy as a last-line strategy. However, in some cases (reported in Tables 2 to 4), either psychiatric or prolactin-related symptoms recurred despite adjustment.
CONCLUSIONS: Clinicians may find it beneficial to prioritize specific antipsychotics (aripiprazole, olanzapine, ziprasidone, or clozapine) over others (risperidone, thioridazine, thiothixene, and remoxipride). Discontinuing DA medication at least periodically until the patient\'s condition improves may also be advisable. If these 2 initial approaches do not yield a significant improvement in symptom management, surgery or radiation therapy may be considered. As patients may respond differently to these therapies, our study still recommends a patient-centered approach.