MON-064 Cabergoline Induced Psychosis in a Patient with Macroprolactinoma

Abstract Disclosure: M.K. Gill: None. J. Tam: None. J.T. woodley: None. S. Mishra: None. Background: Dopamine agonist (DA) therapy with cabergoline is the first-line treatment for hyperprolactinemia. While psychiatric adverse effects of cabergoline are rare, they can significantly impact patient well-being. Case: A 46-year-old Hispanic male presented to the emergency department with progressive vision loss. Imaging revealed a large sellar mass with suprasellar extension, measuring 4.5 x 3.4 cm, with internal hemorrhage and optic chiasm displacement. Laboratory findings included prolactin of 706.6 ng/mL, free thyroxine of 0.46 ng/dL, and random cortisol of 2.63 mcg/dL, consistent with a diagnosis of macroprolactinoma with associated secondary hypothyroidism and secondary adrenal insufficiency. The patient underwent transsphenoidal resection of the pituitary macroadenoma. He was started on cabergoline 1 mg twice weekly, levothyroxine 100 mcg daily, and hydrocortisone (20 mg in the morning and 10 mg in the evening). Two weeks after surgery, the patient was re-admitted with visual hallucinations, impulsivity, and personality changes. He reported hearing God, seeing visuals of crowds and houses indoors. His religious fixations increased with praying multiple times a day. He had no personal or family history of neuropsychiatric disorders. Infectious and metabolic evaluations were unremarkable. Imaging showed postoperative changes with decreased tumor size. Cabergoline was discontinued on admission. The patient was treated with Valproate and Quetiapine. Psychosis symptoms resolved within 10 days of cabergoline discontinuation. Discussion:Among DA, cabergoline is preferred for its efficacy, preferential agonist effect at type 2 dopamine receptors (D2DR), long half-life, and favorable side effect profile1. Common adverse effects include nausea, vomiting, headache, dizziness, vertigo, and hypotension. Rare adverse effects include cardiac valvulopathies, pleuropulmonary fibrosis, and neuropsychiatric complications such as psychosis and impulse control disorders. Cabergoline-induced psychosis is a rare clinical phenomenon reported mainly in case reports. Its prevalence and incidence are not well established. Previous studies indicate that most patients who develop psychosis after cabergoline treatment have a personal or family history of psychiatric disorders2. Discontinuing cabergoline typically leads to symptom resolution, though atypical antipsychotics (e.g., clozapine, aripiprazole) and mood stabilizers (e.g., lithium, valproate) have been used to manage symptoms in some cases2. This case highlights the importance of monitoring for neuropsychiatric complications in patients treated with cabergoline, even in the absence of prior psychiatric history. Presentation: Monday, July 14, 2025