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Elliott Kyung Lee,1,2 Naomi Spitale,2,3 Rebecca Robillard2 1Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; 2Sleep Research Unit, Institute for Mental Health Research (IMHR), Ottawa, Ontario, Canada; 3Department of Medicine, University of Ottawa, Ottawa, Ontario, CanadaCorrespondence: Elliott Kyung Lee, Department of Psychiatry, University of Ottawa, Office 3124, Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario, K1Z-7K4, Canada, Tel +1 613-722-6521 x 6226, Fax +1 613-798-2980, Email elliott.lee@theroyal.caPurpose: Restless Legs Syndrome (RLS) is a sensorimotor disorder associated with an unpleasant urge to move the limbs, relieved with movement, occurring in the evenings and with prolonged rest/inactivity. Treatment with dopamine agonists is effective for up to 60– 90% of affected individuals. However, augmentation, ie, the paradoxical worsening of RLS symptoms after prolonged RLS treatment, is frequently reported, typically after 3– 10 years of treatment. Here, we present 4 patients with RLS who were successfully treated with dopamine agonists but later developed augmentation. A trial of aripiprazole, a dopamine receptor partial agonist (DRPA), was initiated for treatment of augmentation symptoms.Patients and Methods: Four patients treated for RLS with dopamine agonists developed augmentation. In each instance, augmentation symptoms did not respond adequately to a variety of medications including α 2δ drugs, opioids or other agents. A trial of aripiprazole was initiated for each patient, and effects were evaluated.Results: All four patients with severe RLS and augmentation with dopamine agonists achieved symptom control with aripiprazole. Patients endorsed 90– 100% efficacy with aripiprazole by subjective self-report after failures with other agents. Further evaluation with the International Restless Legs Syndrome Study Group RLS Rating Scale (IRLS-SGRS) showed that benefits (from moderate to very severe, to mild to moderate severity) were largely maintained for 1– 2 years. Aripiprazole doses to control augmentation symptoms were low (1– 4 mg). No significant side effects were reported.Conclusion: Aripiprazole may have utility for augmentation in RLS. We speculate that the partial agonist and antagonist properties of aripiprazole may limit potential for dopamine hyposensitization to progress to cause augmentation. Further research is needed to see if aripiprazole and/or other DRPAs are a viable long-term treatment option for patients experiencing augmentation and/or severe RLS with dopamine agonist therapy.Keywords: partial dopamine agonist, Willis Ekbom disease, dopamine treatment, dopamine receptor partial agonist, augmentation, restless legs syndrome, aripiprazole

Medications administered during the neonatal period may mask the diagnosis of congenital hypothyroidism. Herein, we report a case of undiagnosed congenital hypothyroidism while the infant was on treatment with dopamine. Given the inhibitory effect of dopamine on thyroid-stimulating hormone, a high index of suspicion for potential congenital hypothyroidism is needed in such neonates. [ABSTRACT FROM AUTHOR]

To investigate the influence of critical illness on plasma renin activity and aldosterone levels and to examine potential inhibitory effects of dopamine therapy on aldosterone responsiveness, we measured plasma renin activity, and potassium and creatinine in serum, as well as the responses of aldosterone, cortisol and prolactin levels to TRH 200 µg i.v. + Synacthen 0.25 mg i.v. in 63 unselected, critically ill patients (32 females, 31 males, aged 18-84 years). Of the patients 19 received dopamine treatment (3-13 µg/kg/min i.v.); 21 of the patients died in the further course of their disease. Plasma renin activity was increased in 66.7% of the patients and aldosterone levels were elevated in 90.5% of the patients. There were correlations ( P<0.05) of lethality with plasma renin activity and cortisol levels and correlations ( P<0.01) of aldosterone concentrations with plasma renin activity and cortisol levels. Whereas dopamine treatment had no inhibitory effect on aldosterone levels before and after stimulation, prolactin stimulation was decreased in dopamine-treated patients. Thus, dopamine does not generally lose its potency of hormone inhibition in critically ill patients, but has no influence on the secondary aldosteronism developing regularly in the early phase of critical illness, which is apparently mainly due to the stimulatory effect of ACTH (or ACTH-related pituitary peptides) and is considered an epiphenomen of the stress mechanisms acting upon the patients in this condition. [ABSTRACT FROM AUTHOR]

Medications administered during the neonatal period may mask the diagnosis of congenital hypothyroidism. Herein, we report a case of undiagnosed congenital hypothyroidism while the infant was on treatment with dopamine. Given the inhibitory effect of dopamine on thyroid-stimulating hormone, a high index of suspicion for potential congenital hypothyroidism is needed in such neonates., (© The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The article discusses the case of a 64-year-old male diabetic patient who was admitted to the hospital due to renal failure from toxic shock. He had ecthyma gangrenosum in the right leg and septicaemia after taking a mud bath near the sea. He did not respond well to the dopamine therapy because his uninjured leg changed color and his fingers had ischaemia. When the gangrene on his right leg worsened, it was amputated after which his condition improved.