Risperidone Induced Gynecomastia versus Pseudogynecomastia
Antipsychotic medications play a crucial role in managing mental health conditions such as schizophrenia, bipolar disorder, and certain forms of depression. However, One potential side effect that can occur in some individuals is the development of gynecomastia.
Gynecomastia is characterized by the swelling and enlargement of breast tissue in males. It can occur on one or both sides of the chest and may be accompanied by tenderness or discomfort. Gynecomastia can have a significant impact on an individual’s self-esteem and body image, potentially causing psychological distress and social challenges. Understanding the connection between antipsychotics and gynecomastia can help individuals and healthcare providers address this side effect effectively.
Risperidone is associated with higher levels of prolactin elevation than other antipsychotic agents.
Mechanism:
Risperidone ==> high prolactin level ==> suppress hypothalamic GnRH ==> resulting in reduced pituitary gonadotropin secretion ==> this may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients ==> result in galactorrhea, amenorrhea, gynecomastia, and impotence.
Understanding the difference between true-gynecomastia from pseudo-gynecomastia is clinically relevant.
Let’s answer this question first:
- True Gynecomastia: presence of palpable firm disc of freely movable mass of glandular tissue under the areola of nipple.
- Pseudogynecomastia: only swelling of accumulation of fat is felt on palpation.
- Physiological gynecomastia: natural phenomenon occurring during neonatal period and puberty. Pubertal gynecomastia can last from 6-12 months and spontaneously regresses in 95% of cases.
References:
- Psychiatric Annals. 2015;45(4): 208-211.
- Psychiatric Annals. 2015;45(5): 266-272
WATCH FOLLOWING DISCUSSION SERIES
[FOR ACADEMY MEMBERS]
(1) Risperidone and Gynecomastia- Rule out Pseudogynecomastia
This chapter will be summarized in the following sections:
- What important steps should be taken before prescribing risperidone?
- How to differentiate Pseudogynecomastia from true gynecomastia?
- Is risperidone-induced gynecomastia reversible on discontinuation?
- When to monitor for prolactin levels and when to intervene?
(2) Antipsychotics & High Prolactin Level
- Antipsychotics that Increase Prolactin (45 to >100 ng/ml): AVOID
- Antipsychotics that Increase Prolactin (20-50 ng/ml): CAUTION
- Antipsychotics that Increase Minimal Prolactin: PREFERRED
- Antipsychotic that may Lower Prolactin: PREFERRED
(3) Antipsychotics, High Prolactin & Risk of Breast Cancer
This journal club will be discussed in the following eight clinically relevant sections:
- Role of high prolactin levels with risk of breast cancer?
- Which antipsychotics are associated with an increased risk of breast cancer?
- Which antipsychotics are PREFERRED with less/no risk of breast cancer?
- Comparing recently published study on Dec 2021 (Journal of Clinical Psychopharmacology) with 2014 study (Am J Psychiatry).
- What is the normal prolactin level in males and females?
- When is the best time to measure prolactin level?
- What additional laboratory evaluation is needed with elevated prolactin levels?
- How to manage elevated prolactin levels with antipsychotics?
INTERESTED IN LEARNING MORE?
JOIN PSYCHIATRY EDUCATION FORUM ACADEMY MEMBERSHIP
This is a closed membership for medical professionals only.
- 30+ Courses/Sections: Each chapter within these sections is of direct clinical relevance for your daily practice.
- Journal Club: we will post the most recently published psychiatry articles relevant to your daily clinical practice.
- Coffee Club: contain short discussions with clinical experts in the field of psychiatry.
- Clinical Case Discussions: Discussions of clinical cases from our daily clinical practice.
- Discussion Forum & Community: Connect with other medical professionals and discuss your difficult-to-treat clinical cases.
- Essentials of Inpatient Psychiatry Book: All chapters from this book are included in the academy sections.
- Goal: is to have all important clinically relevant topics in one place for ease of access.
