Cabergoline and impulse control disorders: Screening patients with pituitary adenomas in an endocrinology clinic

Cabergoline, a dopamine agonist, is a first-line treatment for prolactinoma. However, de novo impulse control disorders (ICDs) are an increasingly recognized side effect, with reported prevalence up to 59.8 %. This study evaluated risk factors for ICD development and assessed the effectiveness of current screening practices.

Electronic medical records were reviewed for patients seen by endocrinology with a diagnosis of "Benign neoplasm of pituitary gland (D35.2∗)" who had been prescribed cabergoline. Records were examined for ICD risk factors, clinical evidence of ICDs, and documented screening. A subgroup analysis was perfomed among the patients that had been screened.

Among 282 patients on cabergoline, 14 (5 %) developed clinically significant ICDs. ICD development was significantly more common in males (86 % of ICD cases vs. 41 % of non-ICD cases, p = 0.001). No significant associations were observed with race (p = 0.17), ethnicity (p = 1.00), smoking status (p = 0.77), testosterone therapy in males (p = 0.80), psychiatric diagnoses (p = 0.37), or psychotropic medication use (p = 0.48). Patients with ICDs had a higher mean maximum weekly cabergoline dose (2.2 mg vs. 1.3 mg, p = 0.01). Only 26.6 % of patients were screened or informed of ICD risk at the initial visit. Screening was associated with ICD identification: 93 % of ICD patients were screened compared with 17 % of non-ICD patients (p < 0.0001). In the screened cohort, no significant associations with sex or cabergoline dose were observed.

Male sex and higher cabergoline doses were associated with ICD development in the overall population but not in the subgrop of patients that had a documented screening. Other suspected risk factors, including psychiatric comorbidity and testosterone therapy, were not associated with development of ICD-adding nuance to prior findings. Screening was infrequent and disproportionately associated with ICD detection, suggesting underdiagnosis due to lack of proactive assessment. These results highlight the need for universal, standardized ICD screening in prolactinoma patients prior to and during cabergoline treatment.