The side effects of dopamine receptor agonist drugs in Chinese prolactinoma patients: a cross sectional study

Abstract

Background Recently, side effects from Dopamine Receptor Agonist Drugs (DAs) in treating pituitary prolactinoma have raised widespread concern. This study explores the incidence and influencing factors of DAs-related side effects in Chinese prolactinoma patients. Methods A cross-sectional study was conducted. 51 prolactinoma patients treated with DAs, 12 prolactinoma or pituitary microadenoma patients without DAs treatment, and 33 healthy controls were included. The Barratt impulsivity scale-11, Patient Health Questionnaire 9, and the ICD screening questionnaire were all used to evaluate the psychological and physical side effects of DAs. Clinical data of all subjects were collected from their electronic medical records. Results The incidence of ICDs in the treated group, the untreated group, and control group was 9.8% (5/51), 16.7% (2/12), and 9.1% (3/33), respectively. In the treated group in particular, there were 1 patient (2%, 1/51), 2 patients (3.9%, 2/51), and 2 patients (3.9%, 2/51) with positive screening for punding, compulsive shopping, and hypersexuality, respectively. In terms of depression, the incidence of "minimal", "mild" and "moderate" depression in the treated group was 62.8% (32/51), 25.5% (13/51), and 5.9% (3/51), respectively. The incidence of physical symptoms was 51.0% (26/51) in the treated group and gastrointestinal symptoms were the most common symptoms (33.3%, 17/51). In addition, we found that the various parameters of DAs treatment had no association with the occurrence of physical symptoms or ICDs (all P > 0.05). Conclusions Chinese prolactinoma patients treated with DAs had a lower incidence of ICDs (9.8%), while gastrointestinal symptoms were common. In this way, more attention should be paid to side effects, especially physical symptoms, in Chinese prolactinoma patients with DAs therapy during follow-up regardless of dose.

Current and Perspective Approaches to the Treatment of Prolactinomas

“…• gastrointestinal symptoms (dry mouth, loss of appetite, nausea, vomiting, liver failure, constipation, diarrhea); • cardiovascular symptoms (orthostatic hypotension, arrhythmias, worsening of angina, fibrotic changes in the heart valves with prolonged use of large doses); • psychological and neurological symptoms (asthenia, fatigue, dizziness, headache, drowsiness (in this connection preference is given to prescribing drugs in the evening), sleep perversion, insomnia, narcolepsy, somnolence, memory loss, hallucination, paresthesia); • renal symptoms (renal insufficiency) [36][37]. The frequency of occurrence of certain adverse reactions varies in different populations.…”

“…One more challenge in the treatment of prolactinomas with DAs in some patients is development of adverse reactions. The most common DAs side effects are the next: systemic and cutaneous symptoms (edema, skin bruising); respiratory symptoms (chest pain, respiratory distress, dyspnea, hacking cough); gastrointestinal symptoms (dry mouth, loss of appetite, nausea, vomiting, liver failure, constipation, diarrhea); cardiovascular symptoms (orthostatic hypotension, arrhythmias, worsening of angina, fibrotic changes in the heart valves with prolonged use of large doses); psychological and neurological symptoms (asthenia, fatigue, dizziness, headache, drowsiness (in this connection preference is given to prescribing drugs in the evening), sleep perversion, insomnia, narcolepsy, somnolence, memory loss, hallucination, paresthesia); renal symptoms (renal insufficiency) [ 36 - 37 ]. …”

“…Such unpleasant side effects as low blood pressure and nausea Castinetti F. et al refer to the classic and the most well-known ones since DAs were first introduced [ 36 ]. Ke X. et al, based on the analysis of the frequency and manifestations of adverse reactions in Chinese prolactinoma patients treated with DAs, noted the predominance of gastrointestinal symptoms, mainly including loss of appetite and nausea with a low overall incidence of side effects [ 37 ].…”

“…It is noted that patients receiving DAs therapy may develop changes in mood and behavior regardless of prior psychiatric history. These pathological psychological conditions include psychosis, mania, anxiety, depression, confusion, auditory hallucinations, hyperactivity, insomnia, nightmares, paranoia, and impulse behavior disorders [ 36 - 37 , 43 - 44 ]. Ioachimescu A.G. et al, according to the data of the studies, noted that patients treated with DAs therapy also experienced a decrease in quality of life and other personality characteristics compared with the control group [ 43 ].…”

“…Regarding bromocriptine treatment Ke H. et al didn’t find the relationship between duration of the treatment, cumulative and maximum daily doses and the development of side effects [ 37 ].…”