确定并存泌乳素瘤和精神症状患者的理想治疗方法:系统综述。

IF 1.3 4区 医学 Q3 PSYCHIATRY
Awais Paracha, Umar Durrani, Satvik Vasireddy, Ali Abid, Fatima Waheed, Michael Thomure
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引用次数: 0

摘要

目的:泌乳素瘤--过度分泌泌乳素的垂体肿瘤--可引起各种令人烦恼的症状。多巴胺受体激动剂(DA)可减少泌乳素通路中泌乳素的分泌,因此成为治疗泌乳素瘤的一线药物。然而,DA 治疗的主要副作用--多巴胺功能亢进症是精神副作用的明确病因。精神疾病通常使用多巴胺拮抗剂治疗,而多巴胺拮抗剂可诱发高泌乳素血症。这对同时患有泌乳素瘤和精神疾病的患者来说是一个挑战,因为治疗一种疾病可能会加重另一种疾病。本综述旨在为同时患有泌乳素瘤和精神症状的患者确定适当的治疗方案:本综述研究了 PubMed 上从 1960 年到 2023 年用英语发表的涉及人类受试者的引文。纳入的研究包括病例报告、系列病例和队列研究,这些研究涉及同时患有泌乳素瘤和精神症状的患者,并通过脑成像、血清学泌乳素水平、病史或精神症状病历报告进行了验证:专题分析包括 23 份报告,涉及 42 名参与者;42 名患者中有 27 人的泌乳素水平和精神症状显著下降(64%)。对这42名患者的治疗包括停止或改变抗精神病药/多巴胺拮抗剂疗法或停止DA疗法,以减轻精神症状,最后的策略是在药物治疗后进行手术或放射治疗。然而,在一些病例中(见表 2 至表 4),尽管进行了调整,但精神症状或催乳素相关症状仍会复发:临床医生可能会发现,优先选择特定的抗精神病药物(阿立哌唑、奥氮平、齐拉西酮或氯氮平),而不是其他药物(利培酮、硫利达嗪、噻硫酮和雷莫西必利),是有益的。至少定期停用 DA 药物直到患者病情好转也是可取的。如果这两种初步治疗方法不能明显改善症状,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,我们的研究仍然建议采取以患者为中心的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Determining Ideal Management for Patients With Coexisting Prolactinomas and Psychiatric Symptoms: A Systematic Review.

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.

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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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