ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (145 abstracts)
Gambling and cabergoline
Julia Silva-Fernández 1 , Francisco Javier Gómez-Alfonso 1 , Florentino Del Val-Zaballos 1 , Belvís Torres-Arroyo 1 , Paloma González-Lázaro 1 , Álvaro García-Manzanares Vázquez de Agredos 1 , María López-Iglesias 1 , Rafael García-Ruiz 2 & Inés Gómez-García 1
1Endocrinology Service. Hospital La Mancha Centro, Alcázar de San Juan, Spain; 2Neurology Service. Hospital La Mancha Centro, Alcázar de San Juan, Spain.
Introduction: A link between Dopamine agonists and development of impulse control disorders is well recognized in the field of neurology. A similar finding in endocrine patients is emerging.
Case report: We report the case of a 38-year-old man with pathological addiction to gambling associated with low dose cabergoline treatment for a mixed growth hormone (GH) and prolactin (PRL)-secreting pituitary adenoma. At the age of 29 he was diagnosed with mixed (GH and PRL) functioning invasive pituitary adenoma. After surgery and radiotherapy he was given medical therapy with somatostatin analogues and cabergoline. During follow-up somatostatin analogues were withdrawn but he continued cabergoline treatment to control hypersecretion and the residual tumour. During follow-up the patient reported pathological gambling habits. He had spent a large sum of money and, although he had tried to stop gambling many times he was unable to quit. He did not stop his gambling behaviour despite a marital crisis and divorce. He had even been to a centre for addictive disorders without success. We decided to withdraw cabergoline. His impulse-control disorder (ICD) resolved within months after cabergoline discontinuation. After 6 months, somatomedin C level was in normal range, PRL level was mildly high with no sexual dysfunction and the tumour had not grown.
Conclusions: The gambling episodes diminished after the discontinuation of cabergoline, providing evidence for a causal relationship. Cabergoline-induced pathological gambling and another ICDs are probably underreported, and physicians should consider screening for these in patients treated with dopamine agonists. Screening for ICDs should be undertaken in all patients with DA-treated prolactinomas.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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