Endocrine Abstracts

Introduction: Prolactinomas are the most common of functional pituitary tumors. Dopamine agonists are the first line treatment of prolactinomas but have antagonistic effect with antipsychotics (dopamine receptor blockers) used in schizophrenia. The association between these two illnesses is a medical challenge, as the treatment of one disease can exacerbate the symptoms of the other one.

Clinical case: We report the case of a 72-year old man, newly diagnosed with schizophrenia (in March 2022) on the basis of positive symptoms. After two months of daily treatment (dopamine receptor blockers) the patient presented frequent headache. The MRI revealed a pituitary macroadenoma (20×15×18 mm) with cavernous sinus invasion without displacement of the optic chiasma. Hormonal evaluation revealed elevated serum prolactin levels at 4237.29 mUI/l. The other pituitary hormones were normal. The patient was initially treated with 1.5 mg/week of Cabergoline. Two months later, serum prolactin levels were reduced down to 1250 mUI/l. However, the patient developed episodes of visual hallucinations: zoophilia. The decision was to adjust his antipsychotic treatment by adding haloperidol and to reduce the dose of cabergoline down to 0.5 mg/week. The following month was marked by the increase in serum prolactin levels up to 1500 mUI/l with no progression of the macroadenoma showed on MRI and with stabilization of schizophrenia positive symptoms.

Conclusion: Treating a patient with both schizophrenia and macroprolactinoma is a balance between both entities: symptoms and treatment’s side effects. We should monitor the treatment doses to avoid their side effects and exacerbation of chronic diseases.