Psychotic Symptoms Subsequent to Chronic Untreated Prolactinoma: A Case Report

Abstract

Prolactinomas are prolactin-secreting pituitary tumors originating from the lactotroph cells of the anterior pituitary gland. With hyperprolactinemia, prolactinoma patients may present symptoms of galactorrhea, amenorrhea, sexual dysfunction, and infertility, as well as symptoms due to tumor expansion. Moreover, high level of prolactin effects on mood and behavior thus may lead to depression, anxiety, and hostility through unknown mechanisms. A couple of previous case reports described psychotic disorders in patients with prolactinoma, but none of them came from Chinese population. The case presented here is a 24-year-old unmarried woman presenting psychotic symptoms and amenorrhea following menstrual irregularity. Her psychotic symptoms were intermittent and distressed her for 10 months. Her amenorrhea persisted for several years without a standardized therapy. A suspected prolactinoma was confirmed by a high level of serum prolactin and a brain MRI scanning showing a pituitary macroadenoma. Her psychotic symptoms were treated with olanzapine and psychotherapy during hospitalization. She has been maintained on aripiprazole, bromocriptine, and benzhexol after discharge. Olanzapine is effective and safe in treating psychotic symptoms resulting from hyperprolactinemia. Combination of aripiprazole and bromocriptine are a good option for the maintenance of patients with comorbid psychotic symptoms and prolactinoma.