항정신병 약제 치료 중 동반된 프로락틴 분비 뇌하수체 거대선종 치료 1예
A Case of Pituitary Macroadenoma Concurrently Diagnosed in a Patient Undergoing Antipsychotic Treatment
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초록
이전의 연구에서 정신병증과 고프로락틴혈증이 동시에진단되어 bromocriptine으로 고프로락틴혈증을 조절한 증례가 보고된 바 있으나, 정신병증과 프로락틴 분비 뇌하수체거대선종이 동반된 환자에서 두 질환을 약물적인 치료만으로 안정적으로 치료한 증례는 많지 않다. 본 증례에서는 정신분열증으로 항정신병 약제로 장기간 치료를 받던 환자에게 발생한 프로락틴 분비 뇌하수체 거대선종을 진단하여 상반된 치료 기전을 가진 도파민 길항제와 작용제를 동시에처방하여 치료했다. 그 결과 혈청 프로락틴 수치 및 뇌하수체 선종의 크기는 감소하고 정신분열증이 악화되지 않는 등성공적으로 치료되어 문헌고찰과 함께 보고하는 바이다.
Abstract
Antipsychotics are the drug of choice for patients with schizophrenia, but they can induce hyperprolactinemia and growth of pituitaryadenomas by blocking dopamine 2 receptors in the pituitary gland. In contrast, the medical treatment for a prolactinoma is adopamine agonist. Therefore, managing a patient concurrently diagnosed with a prolactinoma and psychosis is challenging. We describea patient with schizophrenia who was diagnosed with a prolactinoma. We changed his neuroleptic to quetiapine and prescribedbromocriptine for the prolactinoma. As a result, the patient was successfully treated with a dopamine agonist and antipsychoticwithout psychotic exacerbation. Our case suggests that dopamine agonists can be administrated to patients with schizophreniaand a prolactinoma without adversely affecting their psychopathological status.
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