Cabergoline-Induced Gambling Causing Increased Adrenal Crisis Episodes

Dopamine agonists have been used in the treatment of acromegaly, but they are modestly effective and are rarely associated with impulse control disorders (ICDs). We present the case of a 34-year-old woman with acromegaly who underwent transsphenoidal resection for an invasive pituitary macroadenoma, followed by the development of panhypopituitarism. Postoperative imaging revealed residual tumor, and her insulin-like growth factor I levels remained elevated, indicating disease persistence. She subsequently received salvage radiosurgery and was treated with lanreotide and cabergoline, achieving biochemical control of her disease. The patient later reported frequent adrenal crisis episodes with worsening anxiety. Four years after initiating cabergoline, she disclosed impulse control behaviors, including pathological gambling, which had resulted in financial stress and emotional strain. Two weeks after discontinuing cabergoline, she had complete resolution of her ICD symptoms with improved anxiety levels and fewer adrenal crisis episodes. In this case, cabergoline-induced gambling contributed to psychosocial stress that likely exacerbated her adrenal crisis episodes. Our case emphasizes the need for routine behavioral screening in patients treated with dopamine agonists. Early identification and discontinuation or dose reductions of dopamine agonists is recommended to allow for ICD resolution and consequently, reducing the risk of exacerbating adrenal crisis episodes.