Impulse Control Disorders in Patients With Hyperprolactinemia on Dopamine Agonist Therapy-How Concerned Should We Be?

Objective: Dopamine agonists (DAs), including cabergoline and bromocriptine, are the mainstay of treatment for prolactinomas. An underappreciated adverse effect associated with DAs is impulse control disorders (ICDs), characterized by the development of compulsive behaviors, including hypersexuality, pathological gambling, binge eating, and compulsive shopping, among others, which can negatively impact patients' and families' lives. This article reviews the prevalence, risk factors, presumed pathophysiology, and diagnostic and management strategies for ICDs in hyperprolactinemic patients treated with DAs.

Methods: Electronic literature searches were conducted to retrieve pertinent articles for inclusion in this article.

Results: The reported prevalence of ICDs in patients with prolactinomas or hyperprolactinemia on DAs ranges from 7.5% to 46% across studies, with cabergoline being more commonly implicated than bromocriptine. Younger age, male sex, and specific genetic polymorphisms appear to increase the risk of ICDs. Diagnostic tools, such as the Minnesota Impulse Disorders Interview, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease, the Barratt Impulsivity Scale-11, and computer-based tests, are instrumental in identifying ICDs. Patient education and periodic screening are advisable for early detection. Management strategies for patients who develop ICDs may include a decrease in DA dose or medication discontinuation, and psychiatric evaluation.

Conclusion: ICDs may occur in patients with hyperprolactinemia on DAs and negatively influence their lives if undetected. Further studies are needed to fully elucidate the risk factors and underlying mechanisms and to identify effective therapies for managing ICDs in patients with hyperprolactinemia on DAs.