Aripiprazole for the Treatment of Antipsychotic-Induced Hyperprolactinemia in an Adolescent Boy.

[Author Affiliation]Rebecca L. Curran. 1 Medical Scientist Training Program, University of Cincinnati, Cincinnati, Ohio.Ismail A. Badran. 2 Division of Child and Adolescent Psychiatry, Cincinnati Childrenu0027s Hospital Medical Center, Cincinnati, Ohio.Virginia Peppers. 2 Division of Child and Adolescent Psychiatry, Cincinnati Childrenu0027s Hospital Medical Center, Cincinnati, Ohio.Ernest V. Pedapati. 3 Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio.Christoph U. Correll. 4 Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of Medicine, Hempstead, New York.Melissa P. DelBello. 5 Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio.Funding: This research was supported by the National Institutes of Health (NIH) under Ruth L. Kirschstein National Research Service Award F30 AI 109893-02 from the National Institute of Allergy and Infectious Diseases, an NIH Medical Scientist Training Program (Grant No. T32 GM063483).Address correspondence to: Ismail Badran, MD, Division of Child and Adolescent Psychiatry, Cincinnati Childrenu0027s Hospital Medical Center, 3333 Burnet Ave, MLC 6015, Cincinnati, OH 45229, E-mail: ismail.badran@cchmc.orgIntroductionSecond-generation antipsychotics (SGA) have numerous metabolic and hormonal side effects (Li et al. 2013). However, there is no standard treatment approach to SGA-induced hyperprolactinemia in adolescents. We present the report of a potential strategy for this condition.CaseD.S. is a 17-year-old boy with bipolar disorder with psychotic features who was evaluated for short stature of more than two standard deviations below mean. D.S. had stable mood for over 1 year while taking paliperidone 6 mg twice daily and lithium 600 mg each morning and 900 mg at bedtime.Laboratories revealed elevated prolactin (185.2 ng/mL, normal: 1.9-14.5 ng/mL) and low total testosterone (34 ng/dL, normal: 158-826 ng/dL), with normal cortisol and thyroid stimulating hormone. The endocrinologistu0027s recommendation was to rapidly decrease D.S.u0027s prolactin levels and begin exogenous growth hormone to increase height before growth plate fusion (Table 1). [Table omitted; see PDF] Paliperidone was cross-tapered with aripiprazole over 1 month. Three weeks after discontinuation, his prolactin was 124 ng/mL (-33%), but he had an exacerbation of mood and psychotic symptoms. Psychomotor agitation and akathisia prompted a switch to valproic acid. Over the following weeks, D.S. developed constant head and tongue movements suggestive of withdrawal of dyskinesia, along with grandiose delusions with command visual and auditory hallucinations. Although his prolactin level normalized to 5.2 ng/mL, the patient as well as his family and treating clinicians decided to restart his original regimen. Head and tongue movements completely resolved within 5 days, and psychotic symptoms resolved over the next 2 weeks.D.S. was then started on concomitant aripiprazole 2. …