The psychiatric ovarian cyst - a case report on psychotropic drug induced large ovarian mass

Aditya Nimbkar; Mounica S. N. Katabathuni; Jigna Garasia; Aditi Nadkarni; Vaibhav Nadkarni

doi:10.18203/2320-1770.ijrcog20261637

Authors

Aditya Nimbkar Department of Reproductive Medicine, Nadkarni's Medical Training Academy and 21st Century Group of Hospitals, Vapi, Gujarat, India https://orcid.org/0009-0001-6700-5581
Mounica S. N. Katabathuni Department of Reproductive Medicine, Nadkarni's Medical Training Academy and 21st Century Group of Hospitals, Vapi, Gujarat, India
Jigna Garasia Department of Reproductive Medicine and Obstetrics and Gynaecology, Nadkarni's Medical Training Academy and 21st Century Group of Hospitals, Vapi, Gujarat, India
Aditi Nadkarni Department of Reproductive Medicine and Obstetrics and Gynaecology, Nadkarni's Medical Training Academy and 21st Century Group of Hospitals, Vapi, Gujarat, India
Vaibhav Nadkarni Department of Reproductive Medicine and Obstetrics and Gynaecology, Nadkarni's Medical Training Academy and 21st Century Group of Hospitals, Vapi, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261637

Keywords:

Hyperprolactinaemia, Letrozole, Infertility, Bipolar disorder, Endoxifen, Ovarian cyst

Abstract

Psychotropic medications used in bipolar affective disorder (BPAD) can disrupt the hypothalamic–pituitary–gonadal axis, leading to hyperprolactinemia, anovulation, and polycystic ovarian morphology. We report the case of a 29-year-old woman with BPAD on long-term multidrug therapy who presented with secondary amenorrhea, infertility, and a large multiloculated ovarian cyst. Evaluation revealed hyperprolactinemia and features mimicking polycystic ovary syndrome. Management included discontinuation of prolactin-elevating drugs and temporary use of endoxifen for psychiatric stabilization. Ultrasound-guided aspiration of enlarged follicles confirmed the functional nature of the cyst. However, persistent follicular enlargement suggested impaired ovulation, likely related to the anti-estrogenic effects of endoxifen. Following its withdrawal, ovulation induction with letrozole and intrauterine insemination resulted in successful conception. This case highlights the reversible nature of psychotropic-induced endocrine dysfunction and emphasizes the importance of individualized, multidisciplinary management.

References

Molitch ME. Medication-induced hyperprolacti-nemia. Mayo Clin Proc. 2005;80(8):1050-7.

Peveler RC, Branford D, Citrome L. Antipsychotics and hyperprolactinaemia. J Psychopharmacol. 2008;22(2 Suppl):98-103.

Qadri S, Hussain A, Bhat MH, Baba AA. Polycystic ovary syndrome in bipolar affective disorder: a hospital-based study. Indian J Psychol Med. 2018;40(2):121-8.

Saxena A, Scaini G, Bavaresco DV, Leite C, Valvassori SS, Carvalho AF, et al. Role of protein kinase C in bipolar disorder: a review of the current literature. Mol Neuropsychiatry. 2017;3(2):108-24.

Legro RS. Letrozole versus clomiphene for infertility in PCOS. N Engl J Med. 2014;371:119-29.