Transtornos psiquiátricos e a influência da Cabergolina na Neoplasia Endócrina Múltipla Tipo 1

Abstract

Multiple endocrine neoplasia type 1 (MEN-1) is a rare, autosomal dominant inherited syndrome caused by germline mutations in the MEN1 gene. MEN-1 is defined by the presence of pituitary, parathyroid and pancreatic tumors in the same individual. Prolactinomas are the most common subtype of functioning HT in MEN-1 and the first line of treatment is cabergoline (CAB), a dopamine agonist (DA). Current evidence warns of the increasing association of DA with impulse control disorders (ICD). ICDs represent an urgent need for certain behaviors such as shopping and/or gambling, hypersexuality and eating disorders. The objectives of the study are: to assess the prevalence of ICDs, anxiety and depression in MEN-1; to identify risk factors for the development of ICD. The following data were collected: sociodemographic and clinical data (psychiatric comorbidity, use of anxiolytics and CAB, dose and time of use) were collected in patients with NEM-1. The Hospital Anxiety and Depression Scale (HAD), Barratt Impulsivity Scale (BIS-11) and short version of the questionnaire for impulsivecompulsive disorders in Parkinson's disease (QUIP-CS) were used as an adaptation of the use of AD in prolactinoma. Sixty-six patients with MEN-1 were evaluated, 36 women (55%) with a mean age of 42 years ± 12 years, 48 (72.7%) classified as having a serious illness, 26 (39%) CAB users and among them 12 (46.2%) also using anxiolytics. HAD detected 41 (62.1%) patients with anxiety symptoms, 22 of whom were men (54%). Of the 41/18 (44%) patients used CAB. Anxiety symptoms were associated with depression in 26 individuals (63%), with a sedentary lifestyle and with higher scores on the BIS-11 and QUIP-CS. The odds ratio was 7.71 for CAB users to also use anxiolytics. HAD detected 30 (45%) patients with depression symptoms, with a predominance of males (63%). We observed in 7/30 (23%) the presence of high impulsivity by BIS-11, sedentary lifestyle in 81% and depressive symptoms concomitant with anxious symptoms in 87%. 8 individuals (12%) were highly impulsive by BIS-11, mean age 44 ± 14 years, 75% men, 50% CAB users, with anxious symptoms in 100% and depressive symptoms in 88%. There was no association between anxiety and depressive symptoms and CAB. Impulsive behaviors were assessed by QUIP-CS in 51 individuals (77%), 31 of whom were women (61%), 22 (43%) CAB users, mean age 42 ± 13 years. The most common subtypes were punding and impulse eating in 44%. Significant associations were men with pathological gambling and hypersexuality; younger age with compulsive shopping; and high BMI with impulse eating. The high frequency of anxiety and depressive symptoms in men and the combination of these two stands out in MEN-1 patients. Although no association was found with CAB use, there was a greater chance of using anxiolytics simultaneously, being more susceptible to the development of psychiatric disorders. Possible risk factors were identified in MEN-1 patients: male gender, younger age, BMI, and patients with anxiety and/or depressive symptoms. TCIs are underdiagnosed because there is no specific assessment tool. It is necessary to monitor adverse effects, especially in more susceptible individuals.