Cabergoline: A first-choice treatment in patients with previously untreated prolactin-secreting pituitary adenoma

Cannavò, Salvatore; Curtò, Lorenzo; Squadrito, S.; Almoto, B.; Vieni, A.; Trimarchi, Francesco

doi:10.1007/bf03343573

Cited by 112 publications

(84 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, hormonal and tumoral responses were obtained in 94 and 82% of the cases respectively. This is in keeping with several previous studies (14)(15)(16)(17)(18), and an overview of the reported numbers of patients with previously untreated macroprolactinoma responding to long-term treatment with CAB is shown in Table 3.…”

Section: Discussionsupporting

confidence: 90%

Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: a study in 122 patients

Delgrange

Daems

Verhelst

et al. 2009

European Journal of Endocrinology

154

104

View full text Add to dashboard Cite

Context: Macroprolactinomas poorly responsive to dopamine-agonists are often more aggressive and are usually termed 'resistant' but this clinical concept has always been defined empirically. Objective: To define resistance to cabergoline (CAB) on the basis of a dose-response relationship established in a large series of macroprolactinoma patients and to assess the influence of gender and tumor invasiveness on the response to treatment. Design: Retrospective study. Methods: One hundred and twenty-two patients (72 women and 50 men) primarily treated with CAB for at least 1 year were included. Main outcome measures were serum prolactin (PRL) and tumor size. Results: Normalization of PRL was obtained in 115 out of the 122 patients (94%). The majority of patients (96/115, 83%) were controlled with a CAB dose %1.5 mg/week. Most of the other patients (19/26) had only a partial resistance, responding to a further increase of the CAB dose. Beyond the dose of 3.5 mg/week, there was no clear advantage in further increasing the dose instead of continuing the treatment at the same dose. Most tumors (98/119 assessable cases, 82%) showed a significant shrinkage during CAB treatment. It was more likely to occur in cases of PRL normalization. Both cavernous sinus invasion and male gender were significantly and independently associated with partial or complete resistance to treatment. Conclusions: Most macroprolactinomas primarily treated with CAB are adequately controlled with doses %1.5 mg/week. About 20% of patients, mainly men and/or those with invasive tumors will require a higher dose of CAB. We suggest defining such patients as resistant to CAB.

show abstract

Section: Discussionsupporting

confidence: 90%

Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: a study in 122 patients

Delgrange

Daems

Verhelst

et al. 2009

European Journal of Endocrinology

154

104

View full text Add to dashboard Cite

show abstract

“…Microprolactinomas are found, almost invariably, more frequently in women, while it is still questioned whether macroprolactinomas are more frequent in men. In fact, some studies have reported an equal distribution of macroprolactinomas between genders (12, 31, 32, this study), others have found higher prevalence in men (33,34) or in women (10,35). In previous studies (7,19) tumor size did not seem to be associated with the duration of symptoms; we did not analyze the duration of symptoms referable to hyperprolactinemia, and patients' age was not correlated with tumor size in either micro-or macroprolactinoma patients.…”

Section: Discussioncontrasting

confidence: 61%

Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia

Colao

Sarno

Cappabianca

et al. 2003

European Journal of Endocrinology

222

136

View full text Add to dashboard Cite

Background: Gender differences in tumor size are supposed to exist in hyperprolactinemia since microadenomas are more commonly found in women and macroadenomas in men. Whether this reflects only a delay in diagnosis in men or a true gender difference in tumor pathogenesis is still unclear. Objective: To prospectively analyze gender differences in the presentation and response to cabergoline treatment in 219 consecutive newly diagnosed patients with hyperprolactinemia.Design: An open prospective design. Subjects: Of the 219 patients of which 145 were women; 107 patients had macroprolactinoma, 97 had microprolactinoma, and 15 had non-tumoral hyperprolactinemia. Methods: Presenting clinical symptoms, prolactin levels and tumor size at magnetic resonance imaging were measured before and 3-6 months after cabergoline therapy. Results: Prevalence of microprolactinomas (56% vs 22%, P ¼, 0:0001) and non-tumoral hyperprolactinemia (10% vs 0%, P ¼ 0:01) was higher in women than in men. Men and women were of similar age (median 32 vs 29 years; P ¼ 0:2) and a similar number had gonadal/sexual dysfunction (85 vs 83%, P ¼ 0:6); weight gain (70 vs 46%; P ¼, 0:0001) and galactorrhea (52 vs 19%; P ¼, 0:0001) were more common in women. Prolactin levels were higher in men than in women, whether exhibiting macro-ð2848^2954 vs 1132^2351 mg=l; P ¼, 0:0001Þ or microadenomas ð187:8^51:8 vs 135:4^60:5 mg=l; P ¼ 0:009Þ and the size of the adenoma was larger in men than in women irrespective of macro-ð25:8^12:4 vs 17:2^7:2 mm; P ¼, 0:0001Þ or microadenoma diagnosis ð8:0^1:4 vs 7:1^1:6 mm; P ¼ 0:04Þ: After treatment, prolactin levels decreased by 89.2 -96.4% in all groups, and normalized more frequently in micro-than in macroadenoma patients (86 vs 64%, P , 0:0001), regardless of gender (70% vs 69%, P ¼ 0:9). Menses resumed in 82% of women, libido disturbances improved in 57% of men. Tumor size was reduced by 45^25% and 52^24% in macroprolactinoma patients and by 44^31 and 38^29% in microprolactinoma patients in women and men respectively. Visual field defects disappeared in 61% of women and in 71% of men ðP ¼ 0:6Þ: Conclusions: Prevalence of macroprolactinomas was similar in men and women; microprolactinomas and non-tumoral hyperprolactinemia were more frequent in women. Clinical symptoms at presentation differed according to gender, with galactorrhea and weight gain more frequent in women. The successful response to cabergoline treatment for 6 months was higher in micro-than in macroprolactinoma patients and was similar in women and men.

show abstract

“…The 50% success rate weobserved for macroprolactinomatreated with bromocriptine is lower than those of several studies (62-67%) which administered higher doses or a long-acting injectable form of bromocriptine in macroprolactinoma patients (2 1-23). On the other hand, the 85%normalization rate we found in idiopathic + microprolactinoma patients in the cabergoline group is comparable to the results of Webster et al ( 15) (83%, 88%, 93% and 96%, respectively), and the 75% normalization rate we found in macroprolactinoma patients is in accordance with the results of Ferrari et al (26), Biller et al (27) and Colao et al (28) (61%, 73% and 81%, respectively), and lower than the 100%rate reported by Cannavo et al (24), who used a higher dose of cabergoline (i.e. 3 mg/week).…”

Section: Discussionsupporting

confidence: 91%

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

et al. 2001

View full text Add to dashboard Cite

Objective It is well knownthat bromocriptine has a suppressive effect on the prolactin release in hyperprolactinemic patients. But it also has someadverse effects. The new, long-acting dopaminergic drug, cabergoline, has been reported to be an effective agent in these patients. However, there are relatively few reports comparing the beneficial and adverse effects of these drugs in the treatment of hyperprolactinemic patients. Therefore, here we studied and compared the efficacy and tolerability of cabergoline with bromocriptine in hyperprolactinemic patients.Patients Seventeen patients (7 with microprolactinoma, 4 with macroprolactinoma, 6 with idiopathic hyperprolactinemia) were given bromocriptine at a dose of 2.5 mg (or 5 mgfor macroprolactinomas) twice daily, and 17 patients (8 with microprolactinoma, 4 with macroprolactinoma, 5 with idiopathic hyperprolactinemia) were given cabergoline at a dose of 0.5 mg twice weekly for 12 weeks. Results At the end of the study, the prolactin reduction was significantly greater in the cabergoline group than in the bromocriptine group (-93 vs. -87.5%, respectively, p<0.05). Normalization of prolactin levels was achieved in 10 of 17 patients (59%) in the bromocriptine group, and in 14 of 17 patients (82%) in the cabergoline group (p=0.13).Twopatients (50%) with macroprolactinoma in the bromocriptine group and three patients (75%) with macroprolactinoma in the cabergoline group demonstrated a normalization of their serum prolactin levels. Adverse events were noted in 53%of bromocriptine patients and in 12% of cabergoline patients (p<0.01). Conclusion These data indicate that cabergoline is a very effective agent for lowering the prolactin levels in hyperprolactinemic patients and that it appears to offer considerable advantage over bromocriptine in terms of efficacy and tolerability.

show abstract

Cabergoline: A first-choice treatment in patients with previously untreated prolactin-secreting pituitary adenoma

Cited by 112 publications

References 26 publications

Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: a study in 122 patients

Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: a study in 122 patients

Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

Contact Info

Product

Resources

About