Pharmacopsychiatry 2008; 41(4): 160
DOI: 10.1055/s-2008-1076721
Letter

© Georg Thieme Verlag KG Stuttgart · New York

Aripiprazole Reduces Serum Prolactin in a Woman with Prolactinoma and Acute Psychosis

A. J. Sheldrick 1 , G. Gründer 1
  • 1Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
Further Information

Publication History

received 10.12.2007 revised 22.01.2008

accepted 29.01.2008

Publication Date:
23 July 2008 (online)

Hyperprolactinemia is a common side effect when treating schizophrenic patients with conventional as well as second generation antipsychotics. Highly potent dopamine D2-receptor antagonistic antipsychotics such as risperodone [4] can cause severe serum prolactin elevations [1] by reversing dopaminergic inhibition and may be associated with a higher rate of pituitary gland tumours [5]. Aripiprazole as a partial D2-receptor agonist [2] could be useful in the treatment of antipsychotic-induced prolactinemia as it has been shown to produce significant reductions of serum prolactin levels [3].

Ms. K., a 39-year-old, single woman from Kazakhstan, was admitted to the hospital with acute psychotic symptoms including auditory hallucinations, paranoid delusions, psychomotor agitation, sleeplessness and disorganized thoughts. There had been no history of psychiatric illness to this date. She denied thoughts of suicide. Ms K. had noticed a decline of sight of her left eye and left visual field three years prior to admission. The MRI of her brain in 2003 reported a pituitary gland adenoma with a degree of optic chiasm compression. She had been treated with the dopamine agonist bromocriptine (2.5 mg) but ceased to take her medicine two months before the psychotic episode. On admittance, laboratory results revealed a serum prolactin level of 39160 mU/L. An additional MRI showed no progression of the tumour. Ms K. did not have galactorrhea or mastopathy but reported missing her menses for a couple of weeks. Risperidone (2 mg) was administered for one week but then switched to aripiprazole because of the contraindication.

Under risperidone and bromocriptine, which had been continued on admission, serum prolactin was still elevated to 9400 mU/L. The treatment with aripiprazole (15 mg) and bromocriptine (2.5 mg) daily led to a complete remission of psychotic symptoms and better sleep. On discharge four weeks after admission, the serum prolactin level was normalized to 159 mU/L.

This case is not conclusive in part because of the use of bromocriptine. However, the rapidity and degree of serum prolactin reduction weigh in favour of a strong role for aripiprazole. On the basis of this case report, further use of aripiprazole may be warranted in the treatment of patients with pituitary gland tumours suffering from psychosis and patients with antipsychotic-induced hyperprolactinemia.

References

  • 1 Brunelleschi S, Zeppegno P, Risso F, Cattaneo CI, Torre E. Risperidone-associated hyperprolactinemia: Evaluation in twenty psychiatric outpatients.  Pharmacol Res. 2003;  48 405-409
  • 2 Koch M. On the effects of partial agonists of dopamine receptors for the treatment of schizophrenia.  Pharmacopsychiatry. 2007;  40 34-39
  • 3 Lee B-H, Kim Y-K, Park S-H. Using aripiprazole to resolve antipsychotic-induced symptomatic hyperprolactinemia: a pilot study.  Prog Neuro-Psychopharmacol Biol Psychiat. 2006;  30 714-717
  • 4 Leuner K, Müller WE. The complexity of the dopaminergic synapses and their modulation by antipsychotics.  Pharmacopsychiatry. 2006;  39 ((Suppl 1)) 15-20
  • 5 Szarfman A, Tonning JM, Levine JG, Doraiswamy PM. Atypical antipsychotics and pituitary tumors: A pharmacovigilance study.  Pharmacotherapy. 2006;  26 748-758

Correspondence

Dr. med. A. J. Sheldrick

Klinik für Psychiatrie und Psychotherapie

Universitätsklinikum Aachen

Pauwelsstr. 30

52074 Aachen

Germany

Phone: +49/241/803 58 91

Fax: +49/241/808 23 97