A systematic review and meta-analysis on impulse-control disorders in patients with pituitary adenomas exposed to dopamine agonists.

BACKGROUND: Patients exposed to dopamine agonists (DAs) may develop impulse-control disorders (ICDs), as shown in Parkinson's Disease. Patients with pituitary adenomas treated with DAs may also have a higher frequency of ICDs. OBJECTIVE: We compared the frequency of ICDs or impulsiveness in patients with pituitary adenomas treated with DAs versus patients with pituitary adenomas not exposed to DAs or healthy controls. METHODS: Observational studies published in any language up to June 30th, 2026 were searched for in PubMed, EMBASE, EBSCO, LiLACS, SCOPUS, and WOS databases. We compared the occurrence of ICDs and impulsiveness scale scores between patients exposed to and not exposed to DAs. RESULTS: Out of 14 studies identified, 10 reported the association between DAs and ICDs, and 6 reported the impact on the Barratt Impulsiveness Scale. DAs were significantly associated with ICDs (random-effects models, OR, 95% CI: 2.39, 1.78-3.21; I2 = 0%, n=1247; p<0.01) regardless of age, sex, cabergoline dose, or treatment duration. There were no indications of publication bias. Exposure to DAs was significantly associated with hypersexuality (3.11, 1.93-5.02, p<0.01, I2 = 0%) and punding (2.53, 1.34-4.78, p<0.01, I2 = 27.6%), but not with pathological gambling (1.94, 0.84-4.49, p=0.12, I2 = 0%) or compulsive shopping (1.46, 0.59-3.36, p=0.41, I2 = 61.3%). CONCLUSION: Patients with pituitary adenomas treated with DAs showed a higher frequency of ICDs. Studies to confirm these findings and investigate the risk factors for ICDs in this patient population are warranted.