SAT629 Do Antipsychotic Medications Cause Prolactinoma Growth? A Systematic Review Of Imaging And Serum Findings

Abstract

Abstract Disclosure: U.S. Durrani: None. Between 2013 and 2018 approximately 4 million adults in the U.S. were reported to be taking antipsychotics. Since increased dopamine levels in the brain are a known etiology for psychosis, antipsychotics function by reducing dopamine levels; dopamine is also a neurotransmitter involved in the regulation of prolactin, a hormone secreted by the pituitary gland which plays a role in lactation and mammary gland development. Prolactinomas are pituitary tumors in which excess prolactin is secreted and their treatment often involves dopamine agonists, which function to decrease prolactin production. Understanding that dopamine agonism decreases prolactin production, our project seeks to examine if dopamine antagonism can cause prolactinoma growth. We aim to answer this question by conducting a PubMed literature review focusing on prolactinoma patients who are concurrently prescribed antipsychotics. Our search yielded 32 studies representing a total of 40 patients. Although imaging data was limited, we used serum prolactin levels as a surrogate marker for prolactinoma growth. Preliminary results uncovered two major themes from our search: the use of certain antipsychotics (risperidone, haloperidol, thioridazine, thiothixene, and amisulpride) was associated with an increase in prolactin levels, and discontinuation led to a decrease in prolactin as well as normalization of the pituitary gland when imaging was provided. However, there were also some exceptions where antipsychotic use had minimal or no effect on prolactinomas. There were 4 patients who took antipsychotics (risperidone, thioridazine) and did not have prolactinoma symptoms until they used other drugs in combination. There were 2 patients taking risperidone without any worsening of their existing prolactinoma when taking the drug in small doses with cabergoline or when using a long acting form. In conclusion, while the relationship between antipsychotic use and prolactinoma growth may not be fully clear, it is known that ceasing medication use can help with treatment of the tumor. We recommend that providers be aware of the potential relationship between these drugs and this tumor and adjust treatment plans accordingly. Presentation: Saturday, June 17, 2023