Endocrine Abstracts

Background: There is increasing evidence that dopamine agonists used to treat hyperprolactinaemia may cause psychiatric side effects. Male patients have been identified to be at increased risk. This study aimed to establish the incidence of cabergoline-induced psychiatric side effects, potential risk factors for their development and to determine the prevalence of counselling and monitoring for these side effects.

Methods: A retrospective cohort study, conducted at a single centre, of patients with hyperprolactinaemia who received an outpatient cabergoline prescription between January 2018 and December 2022. Data were collected for patients who did and did not develop psychiatric side effects, including cabergoline dose and duration, sex hormones and prolactin, counselling, and monitoring.

Results: 257 patients were included (61 males, 196 females). 8.6% (n=22) developed psychiatric side effects secondary to cabergoline, with mood disorders being the most common. Incidence of these side effects was similar between men and women. There was no difference in baseline prolactin between groups. However, baseline hypogonadotrophic hypogonadism was associated with an increased risk of developing psychiatric side effects (OR=8.22; CI=1.62 to 150.1; P=0.04). Over the five-year study period, 47.5% of patients (n=122) were counselled about psychiatric side effects prior to cabergoline initiation, with enquiry into these at least once during follow-up in 48.6% of patients (n=125). The prevalence of both counselling and monitoring for these side effects increased year-on-year from 2018 to 2021.

Conclusions: Patients with baseline hypogonadotrophic hypogonadism may be at increased risk of developing psychiatric side effects secondary to cabergoline treatment of hyperprolactinaemia, but this requires further research. A consistent approach to counselling and monitoring is needed. Future studies should explore and validate effective, practicable tools for screening and monitoring.