MON-068 Cabergoline Induced Pathological Gambling Causing Increased Episodes of Adrenal Crisis in a Patient with Acromegaly and Secondary Adrenal Insufficiency

Abstract Disclosure: M. Martinez Gil: None. K.C. Yuen: None. Background: Impulse control disorders (ICDs) (e.g., pathological gambling, hypersexuality, compulsive shopping and binge eating) has been reported with dopamine receptor agonists (DAs) used to treat hyperprolactinemia, Parkinson disease and restless leg syndrome. Cabergoline, the preferred DA for treating hyperprolactinemia, is also used but off-label for treating acromegaly. The mechanism for DA-induced ICDs is attributed to the stimulation of dopamine D2 receptors within the mesolimbic pathway, a neural circuit critical for reward-driven behaviors. This abnormal behavior can lead to detrimental psychosocial consequences that ceases upon drug discontinuation. Small surveys have reported that ICDs are unrecognized in > 50% of cases and some patients, when asked, may not disclose or even minimize the disorder. Case: A 34-year-old woman with acromegaly underwent transsphenoidal surgery in 2017 for a pituitary macroadenoma (3.5 x 3.2 x 2.8 cm) with suprasellar extension and mass effect on the optic chiasm. Postoperatively, she developed hypopituitarism with secondary adrenal insufficiency, hypogonadism and hypothyroidism. Despite successful decompression of the optic chiasm, a residual tumor (1.8 x 1.4 x 13 cm) remains visible on MRI encasing the right cavernous sinus and her 3-month postoperative IGF-I did normalize at 557 ng/dL (range 81-278 ng/dL). Because of persistence of disease after surgery, our patient underwent radiosurgery in 2018 followed by lanreotide and cabergoline therapy, which subsequently normalized her IGF-I levels and improved her acromegaly symptoms. During the 6 years of cabergoline therapy at 0.5 mg twice a week, she noted increased compulsion for financial gain by gambling which caused increased family strife, severe anxiety and increased adrenal crises episodes, some of which required hospitalization. She was too embarrassed to disclose this behavior to her endocrinologist until her mother discovered on the internet of the link between DAs and ICDs. After 2 weeks of stopping cabergoline, her ICD symptoms and anxiety gradually resolved, and she has not reported any further serious adrenal crisis episodes since. Conclusion: We report the first case of cabergoline-induced pathological gambling in a patient with acromegaly that significantly increased her anxiety levels that subsequently potentiated her increased adrenal crises episodes. Our case underscores the importance of close physician monitoring and counseling DA-treated patients, families and caregivers to recognize and report any ICDs to their providers and their potential to exacerbate life-threatening adrenal crisis if there is concurrent adrenal insufficiency. Additionally, as no DA drugs currently approved by the FDA have boxed warnings about its association with ICDs as part of the prescribing information, our case highlights the need for these prominent warnings. Presentation: Monday, July 14, 2025