MON-277 Patient Health Questionnaire 9 (PHQ-9) and Barrat Impulsivity Scale (BIS-11); Tools to Identify Side Effects of Dopamine Agonist Treatment in Patients with Pituitary Adenomas
Authors: Hinojosa-Amaya José Miguel , Johnson Nathaniel , Varlamov Elena V , González-Torres Christine , Yedinak Christina G , McCartney Shirley , Fleseriu Maria 
Published: May 2020

Abstract
Background There is augmented concern for dopamine agonists (DA) related risk to mood and impulse control disorders (ICD) in patients (pts) with pituitary adenomas (PA). In this study, we analyzed prevalence using two validated self-assessment screening surveys; PHQ-9 and BIS-11. Methods A retrospective review of pts from an IRB approved PA registry. Patients; DA treated group (DA-T) and DA nontreated controls (DA-C). Patietns with previous psychiatric diagnoses, and taking anti-depressive or anti-psychotis, were excluded. BIS-11 score ≥ 75%ile (&gt;61 points) was considered an increased ICD risk. DAs maximum standard dose low (MSDL) and high (MSDH), were calculated (2.0 and 3.5 mg/week for cabergoline (Cab) and 7.5 and 15 mg/day for bromocriptine; Bromo). Stats SPSS v.25. Results 103 pts (61 female, mean age 42.38±5.38 years) were included. 76 were DA-T (70 Cab, 6 Bromo) and 27 DA-C. Median MSDL was 0.5mg (IQR: 0.25-0.75), MSDH was 0.28mg (IQR: 0.14-0.42). Median prolactin was 12.7ng/ml (IQR: 4.35-51.6). Overall median PHQ-9 score was 4 (IQR=2-9) and median BIS-11 score was 52 (IQR: 47-61). Per PHQ-9, 11/103 pts had major depressive disorder (MDD); 10 (13.2%) DA-T, 1 (3.7%) DA-C, p=0.28. 12/103 pts had other depressive disorder (ODD); 7 (9.2%) DA-T, 5 (18.5%) DA-C, p=0.19. 8 pts had thoughts of self-injury; 6 (7.9%) DA-T, 2 (7.4%) DA-C, p=NS. Severe depression was found in 3, (3.9%) DA-T pts only, moderately severe in 7 (9.2%) DA-T and 2 (7.4%) DA-C, moderate in 8 (10.5%) DA-T and 1 (3.7%) DA-C, and mild in 18 (23.7%) DA-T, 12 (44.4%) DA-C, p=NS. For BIS-11 (97 pts) median score was 52.0 (23-104) for DA-T, 52.5 (38-77) for DA-C. 23 pts had a score ≥ 75%ile, 18 (26.1%) DA-T and 5 (20%) DA-C. Younger pts (36±14.8 vs 43.5±15.09 years; p=0.043) and lower DA cumulative doses had significantly higher ICD scores (median 18.27, IQR 11.5-313.98 vs 120.4, IQR 48.04-296.5; p=0.022). Differences in prolactin levels and sex were not significant. Per PHQ-9; 26.1% of pts with vs 5.3% without increased ICD risk had MDD (p= 0.013). Depresion severity and the total PHQ-9 score were higher in pts with increased ICD risk (p≤0.001). Pts with an increased ICD had higher odds of having thoughts of death or self-harm (OR=6.29 CI95% 1.37-28.86, p=0.01). Discussion The data shows a trend of higher impulsivity among DA treated pts. Pts with increased ICD risk had higher odds of MDD, self-harm ideation and thoughts about being dead. In contrast with previous studies, prolactin and male sex were non-significant for increased ICD, while a lower DA cumulative dose was significant. We suggest ICD is more likely to appear in DA naïve or pts recently taking DA. Conclusion Routine self-assessment questionnaires PHQ-9 and BIS-11 during office visits may be useful to identify patients at risk of depression and ICD in pts with DA treated PA.