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Aripiprazole exhibits partial agonistic activity on Dopamine (D2) receptors and serotonin receptors which renders it useful in the treatment of psychiatric disorders and improvement of hyperprolactinemia, accompanied by the advantage of having a low side effect profile. We propose the utility of low dose Aripiprazole as a single agent for the treatment of hyperprolactinemia in comparison to conventional dopamine agonists or as adjunctive therapy in psychiatric settings. Over the next 8 weeks, prolactin levels decreased to 476 accompanied by a steady improvement in her mental state. Following this endocrinology opinion was sought and treatment with low dose Aripiprazole 10 milligrams as a single agent was started with the aim of improving her mental state in conjunction to her prolactin levels. Brain imaging was done which revealed a Macroprolactinoma. Her clinical features of excessive hoarding, extreme self-neglect and lack of insight into her symptoms were consistent with DS. She described none of the common features associated with hyperprolactinemia. Rest of her pituitary profile was unremarkable. As part of workup prior to commencing antipsychotic therapy, she was found to have prolactin levels of 11146 (0≤95 mU/l). We report the case of a 77-year-old woman, not known to psychiatric services and on no anti-psychotic treatment, was subsequently diagnosed with Diogenes syndrome (DS). DS is a behavioural disorder, mostly seen in elderly population, characterized by self-neglect, domestic squalor, apathy, compulsive hoarding and lack of shame regarding one’s living condition. The uniqueness of this case is attributed to the usage of low-dose Aripiprazole as a novel agent in the treatment of hyperprolactinemia associated with Diogenes syndrome (DS).

Treatment options when symptomatic usually constitute dopamine agonist therapy, the common agents being Cabergoline and Bromocriptine. It is often seen as a side-effect with usage of anti-psychotics. It is a relatively common condition encountered in the world of endocrinology. Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood.