Abstract
Atypical antipsychotic drugs such as clozapine, olanzapine, quetiapine, sertindole and ziprasidone are not usually associated with significant hyperprolactinemia [1]. Report also suggests that olanzapine is a safe and alternative treatment for cases with antipsychotic-induced hyperprolactinemia [2].
In the existing literature there are only two cases of galactorrhea due to hyperprolactinemia with olanzapine [3], [4]. However, there are no reports of gynecomastia induced by olanzapine. In this regard, we wish to report a case of olanzapine-induced gynecomastia in a young male with schizoaffective disorder, who developed gynecomastia while on olanzapine therapy.
Mr K, a 26-year-old male, presented with a history of suspiciousness, auditory hallucinations, Capgras delusions and suicidal ideas, of 3-months duration. His medical history did not reveal any symptom or sign suggestive of endocrinological disorder including gynecomastia. This was his first psychotic episode, which was progressive in nature with no significant physical or psychological stressor. Hewas diagnosed as having schizoaffective disorder, and was put on imipramine 100 mg/day and olanzapine 20 mg/day.
The combination of olanzapine and imipramine was continued for 6 weeks, and subsequently, imipraminewas gradually tapered down and stopped over a period of 2 weeks. He was then maintained on olanzapine 20 mg/day.
At week 3 of olanzapine monotherapy, he complained of swelling in the breast. Local examination revealed a bilateral non-tender nodular growth of around 3 cm by 3 cm area, surrounding the nipple, without galactorrhea. Laboratory tests revealed increased serum prolactin level 19 ng/mL (normal range in males: 1.5–15.0 ng/mL). The same test repeated 1week later revealed a further increase in serum prolactin levels (30 ng/mL).
A detailed organic work-up was negative. Olanzapine was discontinued and replaced with quetiapine, which was built up to 300 mg/day. The serum prolactin level at week 3 of quetiapine therapy was 6 ng/mL. Four weeks after olanzapine was stopped, there was a complete disappearance of nodular growth in both breasts.
In men, prolactin elevation can cause impotence, decreased libido and hypospermatogenesis [1]. To our knowledge, this is the first published case of hyperprolactinemia and gynecomastia associated with olanzapine. The temporal correlation between olanzapine initiation and appearance of gynecomastia, and its disappearance upon olanzapine discontinuation, with subsequent normal serum prolactin level leaves little doubt that the gynecomastia was induced by olanzapine. In two previously reported cases of galactorrhea associated with olazapine in women, one case had been exposed to risperidone and haloperidol previously [4]; and in the other case, a womanwith mild mental retardation had a history of birth anoxia, developed euprolactinemic galactorrhea while on olanzapine in which serum prolactin level was 13 ng/mL (normal range=3–30) [3]. Our case had neither been exposed to any other antipsychotic drugs, nor was there any history suggestive of cerebral insult.