Endocrine Abstracts

Introduction

Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood. It is a relatively common condition encountered in the world of endocrinology. It is often seen as a side-effect with usage of anti-psychotics. Treatment options when symptomatic usually constitute dopamine agonist therapy, the common agents being Cabergoline and Bromocriptine. The uniqueness of this case is attributed to the usage of low-dose Aripiprazole as a novel agent in the treatment of hyperprolactinemia associated with Diogenes syndrome (DS). DS is a behavioural disorder, mostly seen in elderly population, characterized by self-neglect, domestic squalor, apathy, compulsive hoarding and lack of shame regarding one’s living condition.

Case details

We report the case of a 77-year-old woman, not known to psychiatric services and on no anti-psychotic treatment, was subsequently diagnosed with Diogenes syndrome (DS). As part of workup prior to commencing antipsychotic therapy, she was found to have prolactin levels of 11146 (0–495 mU/l). Rest of her pituitary profile was unremarkable. She described none of the common features associated with hyperprolactinemia. Her clinical features of excessive hoarding, extreme self-neglect and lack of insight into her symptoms were consistent with DS. Brain imaging was done which revealed a Macroprolactinoma. Following this endocrinology opinion was sought and treatment with low dose Aripiprazole 10 milligrams as a single agent was started with the aim of improving her mental state in conjunction to her prolactin levels. Over the next 8 weeks, prolactin levels decreased to 476 accompanied by a steady improvement in her mental state.

Conclusion

We propose the utility of low dose Aripiprazole as a single agent for the treatment of hyperprolactinemia in comparison to conventional dopamine agonists or as adjunctive therapy in psychiatric settings. Aripiprazole exhibits partial agonistic activity on Dopamine (D2) receptors and serotonin receptors which renders it useful in the treatment of psychiatric disorders and improvement of hyperprolactinemia, accompanied by the advantage of having a low side effect profile. Literature review depicts limited evidence and reports of Aripiprazole being used as a single agent to treat hyperprolactinemia as opposed to significant number of studies where it has been used as adjunct therapy. Of note, frontal lobe dysfunction has been postulated to account for Diogenes syndrome, however on the other hand, the involvement of Pituitary lesions especially prolactinomas, has not been well documented.