A 29-year-old lady comes to the hospital for complaints of oligomenorrhea for past 3 years. She attained menarche at 14 years and has had regular cycles since then. Over the last three years, she has gained 8–9 kilos of weight gradually. She has no complaints suggestive of galactorrhea, hot flashes or symptoms suggestive of thyroid dysfunction. She has been married for 3 years and wants to plan a pregnancy soon. Her last menstrual period was 15 days ago. She suffers from dyspepsia for which she uses pantoprazole and domperidone tablets 4–5 times a week. Her family has a history of thyroid dysfunction. On examination, she has a body mass index of 28.5 kg/m2. On general examination, she has grade 2 goiter, acanthosis, modified Ferriman–Gallwey score of 12/36 and expressive galactorrhea unnoticed before. Clinical examina- tion is not suggestive of any other illness like hypothyroidism or thyrotoxicosis, Cushing’s syndrome or acromegaly. Confrontation test is normal. Skin and ankle jerk normal.
Galactorrhea may be overlooked unless actively elicited.
Laboratory Examination Reveals Thyroid-stimulating hormone (TSH) 2.5 micro IU/L. Total T4 10 mg/dL, prolactin 160 ng/mL, urine pregnancy test negative. Ultrasound pelvis shows ovarian volume 12 cm3 with numerous cysts in both ovaries peripherally. A diagnosis of hyperprolactinemia, probably drug induced is made.
What are the side effects of dopamine agonist agents?
Medicine
Nausea occurs in up to 50% of patients. Nasal stuffiness, depression, and digital vasospasm occur, the latter more frequently with higher doses. Postural hypotension, exacerbation of pre-existing psychosis and rarely serious side effects like hepatic dysfunction, cardiac arrhythmia, retroperitoneal fibrosis, pleural effusions have been described. There have been concerns regarding ergot containing dopamine agonists with serotonergic properties (bromocriptine and cabergoline) being associated with a risk for heart valve regurgitation when used in Parkinson’s disease in much higher doses and longer duration than hyperprolactinemia. There is no conclusive evidence for such an association at the low doses used for hyperprolactinemia.
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