Dopamine Agonist-Induced Impulse Control Disorders

Dopamine agonists (DA) are widely used in the management of prolactinomas, as they are largely effective in controlling tumor secretion and growth. Dopamine agonist administration is safe with only minor adverse effects reported in most cases (e.g., gastrointestinal symptoms and postural hypotension). Neuropsychiatric side effects such as impulse control disorders (ICD; e.g., pathological gambling, compulsive shopping, and hypersexuality) have been described in neurological patients treated for Parkinson’s disease and restless leg syndrome with high doses of DA. Accumulating evidence suggests that ICD in patients with prolactinomas treated with DA are not as rare as previously thought. We describe a case of microprolactinoma in a perimenopausal female with no known psychiatric history. The patient developed disruptive symptoms of hypersexuality after treatment with cabergoline, which subsequently resolved when cabergoline was discontinued. Increased awareness regarding possible psychiatric adverse effects with DA administration is needed among endocrinologists, and caution should be exerted in prescribing and monitoring treatment effects.