Increased impulsivity and higher odds of compulsive shopping among cabergoline-treated patients with prolactinoma: a case-control study

Dopamine agonists, particularly cabergoline, are the first-line treatment for prolactinomas, but have been associated with impulse control disorders (ICDs). However, data on impulsivity and related behaviors in this population remain limited and inconsistent. OBJECTIVE: To evaluate impulsivity and ICDs in patients with prolactinoma treated with cabergoline and to compare these findings with healthy controls. METHODS: This case-control study included 131 patients with prolactinoma receiving cabergoline and 131 healthy controls. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), and ICDs were evaluated using specific questionnaires addressing hypersexuality, gambling, compulsive shopping, and punding. Multivariable analyses were performed to assess independent associations. RESULTS: Patients treated with cabergoline exhibited higher overall impulsivity, reflected by increased BIS-11 scores and a higher proportion of individuals with increased impulsivity (BIS-11 ≥ 60). Attentional impulsivity remained significantly higher in patients after multivariable adjustment. Patients also had more than fourfold higher odds of compulsive shopping compared with controls, whereas no significant differences were observed for other ICDs. Lower educational level was also associated with higher impulsivity across all BIS-11 domains and with compulsive shopping. CONCLUSION: Patients with prolactinoma treated with cabergoline exhibit increased impulsivity, particularly in the attentional domain, along with higher odds of compulsive shopping. These results highlight the role of dopaminergic modulation and the influence of sociodemographic factors, supporting the importance of actively assessing impulsivity during clinical follow-up.