Background: Risperidone is a second-generation antipsychotic medication, which inhibits dopamine and serotonin receptors. Around half of children and adolescents treated with risperidone develop hyperprolactinemia. Chronic hyperprolactinemia can lead to osteoporosis, cardiovascular disease and delayed growth and puberty. There is no available guidance on management of antipsychotic induced hyperprolactinemia in children. We describe the challenges in the management of a teenage girl with severe autism who had significant problems with symptomatic hyperprolactinemia secondary to risperidone therapy.
Case: A 15-year-old girl with severe autism was referred for Endocrinology consultation due to problems related to galactorrhea secondary to hyperprolactinemia. She was on risperidone (0.5 mg twice daily) from 13 years of age for severe behavioural difficulties with outbursts of aggression. At 15 years of age, she presented with excessive weight gain, galactorrhea and secondary amenorrhoea. Endocrine work up revealed a normal thyroid function and a very high prolactin concentration of 3053 mU/l (normal: 0500). Macroprolactin concentration was 8%. The MRI scan of the pituitary was normal. Cabergoline 125 microgram three times a week resulted in gradual resolution of the symptoms with fall in plasma prolactin concentration to 958 mU/l over a period of 12 months. Risperidone was subsequently weaned and stopped. Frequent blood sampling to monitor prolactin concentrations was extremely challenging due to her severe behavioural difficulties. It was only possible to obtain blood samples, during the times, when the patient was anaesthetised for medical procedures.
Conclusion: Cabergoline can help ameliorate the symptomatic hyperprolactinaemia secondary to risperidone therapy in children. Frequent monitoring of serum prolactin concentration is a challenge in this group of patients due to the underlying nature of the condition. It is important to develop evidence-based guidelines for optimal management of hyperprolactinemia in children and young people on antipsychotic therapy.
01 Oct 2015 - 03 Oct 2015