Citation

Hinojosa-Amaya JM, Johnson N, González-Torres C, Varlamov EV, Yedinak CG, McCartney S, Fleseriu M. Front. Endocrinol. (Lausanne) 2020; 11.

Copyright

(Copyright © 2020, Frontiers Research Foundation)

DOI

10.3389/fendo.2020.579606

PMID

unavailable

Abstract

BACKGROUND: Dopamine agonists (DA) are the first line therapy for prolactinoma and symptomatic hyperprolactinemia; use as an adjuvant treatment for acromegaly and Cushing's disease is rare. Some patients develop de novo psychiatric symptoms or have exacerbation of pre-existing conditions during DA therapy. A practical, clinically sensitive depression and impulse control disorders (ICD; particularly hypersexuality and gambling disorders) detection tool is important for identifying at risk patients. The Barratt Impulsivity Scale (BIS-11) and the 9-item Patient Health Questionnaire (PHQ-9) are sensitive in identifying impulsivity and depression.

OBJECTIVE: Detail use of the BIS-11 and PHQ-9 as screening tools for depression and ICD in patients with pituitary disease at a high-volume academic pituitary center.

METHODS: DA-treated and naïve patients with pituitary disease were included. Patients with a known history of depression or psychiatric disorder were excluded. PHQ-9 standardized interpretation criteria were utilized to classify depression severity. For BIS-11, threshold was established based on previous studies. Statistical analysis was with SPSS version 25.

RESULTS: Seventy-six DA-treated and 27 naïve patients were included. Moderate and moderately severe depression were more prevalent in DA-treated patients; severe depression only found in DA-treated patients. A normal BIS-11 score was noted in 76.69%; higher scores (not significant) were noted in DA-treated patients. There was a positive correlation between higher BIS-11 and PHQ-9 scores; higher in DA-treated patients (r = 0.52, p < 0.001) than DA-naïve patients. Patients with BIS-11 scores ≥60 were younger and received lower cumulative DA doses compared to patients with BIS scores <60. There was no association between male sex and BIS-11 ≥60 and male sex did not increase the odds of increased scores (OR = 0.66, CI95% 0.25-1.76, p = 0.41). No significant difference was found for macroadenoma, prolactin levels, testosterone levels, hypogonadism, testosterone replacement in men, and increased impulsivity or depression scores.

CONCLUSION: Use of PHQ-9 and BIS-11 is practical for routine screening of depression and ICD during outpatient pituitary clinic visits for patients with pituitary disease both naïve to treatment and during DA therapy. We recommend close follow-up after initiation of DA therapy for younger patients, regardless of dose. © Copyright © 2020 Hinojosa-Amaya, Johnson, González-Torres, Varlamov, Yedinak, McCartney and Fleseriu.

Language: en

Keywords

adult; human; cognition; suicide; female; male; depression; disease severity; testosterone; death; major clinical study; questionnaire; attention; retrospective study; pathological gambling; prolactin; automutilation; impulsiveness; cross-sectional study; hyperprolactinemia; motor performance; side effect; impulse control disorder; bromocriptine; self control; hypogonadism; Article; Barratt Impulsiveness Scale; treatment duration; dopamine receptor stimulating agent; acromegaly; hypophysis adenoma; cabergoline; patient health questionnaire; impulsivity; Patient Health Questionnaire 9; prolactinoma; androgen therapy; dopamine agonist; hyperprocalctinemia; impulse control (pathology) disorders; macroadenoma; pituitary tumor