Risperidone and paliperidone-induced galactorrhea in pediatric age: assessing the risk/benefit of the medication (case report)
DOI:
https://doi.org/10.32385/rpmgf.v41i1.14078Keywords:
Galactorrhea, Antipsychotics drugs, Children, Adverse drug reaction, Case reportAbstract
Introduction: Galactorrhea is a rare symptom in childhood. The differential diagnosis is extensive, and further investigation is necessary, aided by a detailed anamnesis and physical examination.
Case description: A 4-year-old boy with a history of impulsive behavior had been taking risperidone 0.20mg/day for four months. He was observed at his primary health care facility (PHCF) due to a bilateral whitish nipple discharge within one week of evolution. No other symptoms were reported. On physical examination, bilateral galactorrhea was observed. The remaining physical examination was normal. A blood test revealed normal thyroid hormone levels but an increased serum prolactin. Risperidone was discontinued, additional blood tests were scheduled, and the patient was referred to a pediatric endocrinology (PE) consultation. He became asymptomatic after two weeks of discontinuing risperidone. He maintained reassessment appointments at his PHCF. At PE consultation, he repeated blood tests which revealed normalized prolactin levels. For the management of persistent impulsive behavior, paliperidone was initiated at a dosage of 3mg/day. However, after four months, bilateral galactorrhea recurred. Paliperidone was also discontinued and psychoeducation measures were emphasized.
Comment: The authors aim to emphasize that antipsychotic drugs are among the main causes of galactorrhea, even in children. Despite the serious differential diagnosis of galactorrhea, suspending imbalance-predisposing hormonal drugs can be a valid therapeutic test, avoiding unnecessary imaging exams in the initial phase of the investigation.
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