Clinical use of cabergoline as primary and adjunctive treatment for acromegaly

Moyes, Veronica; Metcalfe, Karl; Wm, Drake

doi:10.1530/eje-08-0306

Cited by 50 publications

(25 citation statements)

References 24 publications

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“…The use of CAB as a monotherapy after unsuccessful surgery has only been evaluated in small series, many with pre-selection of patients and with short follow-up periods [3][4][5][15][16][17]. In a recent meta-analysis, the efficacy of CAB as a monotherapy was evaluated, and only 10 studies including a total of 160 patients were found in the literature [15].…”

Section: Cab As An Adjuvant Therapymentioning

confidence: 99%

Cabergoline treatment in acromegaly: cons

Kasuki

Neto

2014

Endocrine

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Many options are available for the treatment of acromegaly, including surgery, radiotherapy, and medical treatment. Cabergoline (CAB), a dopamine agonist with high affinity for dopamine receptor type 2, has been used both in monotherapy and in conjunction with somatostatin analogs (SSAs). Although it is administered orally and has a relatively lower-cost in comparison with SSAs, few studies have demonstrated its usefulness, there is a lack of randomized-controlled trials and other drugs (SSAs and pegvisomant) with more data in the literature are available; these issues are the main drawbacks of adopting CAB for the treatment of acromegaly.

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Section: Cab As An Adjuvant Therapymentioning

confidence: 99%

Cabergoline treatment in acromegaly: cons

Kasuki

Neto

2014

Endocrine

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“…Higher response rates with normalization of IGF-1 in 20%-33% of patients have been reported in more recent studies using cabergoline. [76][77][78] In prior studies, pretreatment prolactin levels appeared to correlate with IGF-1 response rate to dopamine agonist therapy; however, this effect was not seen in the metaanalysis. Higher baseline prolactin levels did correlate with tumor shrinkage, which occurred in approximately one-third of patients.…”

Section: Dopamine Agonistsmentioning

confidence: 80%

An update on the treatment of acromegaly

Edling¹,

Heaney²

2013

RRED

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Acromegaly is caused by pituitary somatotroph hypersecretion of growth hormone leading to elevated hepatic-derived and local levels of insulin-like growth factor-1. It is associated with increased morbidity and mortality due primarily to cardiovascular disease and diabetes mellitus. Normalization of growth hormone and insulin-like growth factor-1 levels has been associated with decreased morbidity from metabolic and cardiovascular effects, as well as reduced overall mortality in epidemiologic studies. Many patients experience a delay in obtaining a diagnosis, have pituitary macroadenomas at presentation, and accordingly, a significant number will not be cured by tumor surgical resection alone. Adjunctive radiation therapy cannot always offer biochemical and clinical disease control and carries a 40% risk of partial or total pituitary failure in the medium term. Several monotherapies or combination medical therapies are currently available for both primary and adjuvant acromegaly treatment, and include long-acting somatostatin analogs, the growth hormone receptor antagonist pegvisomant, and dopamine agonists. Next generation somatostatin analogs and new drug delivery methods of existing agents are in ongoing clinical studies. This paper will review current and novel therapies under development for acromegaly.

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“…Some studies have suggested that co-secretion of prolactin may predict response, but this has not been supported by other studies. 32,33 When used in higher doses (e.g., greater than 3 mg daily) in patients with…”

Section: Dopamine Agonistsmentioning

confidence: 99%

Diagnosis and Management of Acromegaly in 2014 (Update from 2012)

Katznelson¹

2015

European Endocrinology

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Acromegaly is an uncommon disorder that, in the vast majority of cases, is the result of a growth hormone (GH)-secreting pituitary adenoma. Because tumors are often macroadenomas at the time of diagnosis, there may be a number of signs and symptoms related to local mass effects, including headache, visual field loss, ophthalmoplegia, and hypopituitarism. Chronic GH and insulin-like growth factor 1 (IGF-1) hypersecretion can lead to soft tissue and bone overgrowth manifestations, medical comorbidities, and accompanying clinical features. Medical comorbidites include arthropathy, cardiomegaly, type 2 diabetes, hypertension, sleep apnea syndrome, and colon polyps. In addition, acromegaly is associated with premature mortality, primarily owing to cardiovascular disease. Appropriate therapy of acromegaly can lead to improvement in these comorbidities and reversal of the premature mortality risk. This current review is an update to the 2012 summary. Diagnosis of AcromegalyThe diagnosis of acromegaly begins with a clinical suspicion by the physician that the patient has this disease. Typical physical examination findings include hand and foot enlargement or facial bone enlargement and acral/soft tissue changes. Of note, subjects usually do not present with a chief complaint related to acral growth. In women, the most common presenting complaint is amenorrhea. 2Biochemical testing involves measurement of GH and IGF-1. GH, produced by the somatotroph cells of the pituitary gland in a pulsatile fashion, circulates and stimulates hepatic secretion of IGF-1. In the recent Endocrine Society guidelines on the approach to acromegaly, it was recommended that a serum IGF-1 level be measured in subjects with acral manifestations. Owing to the lack of agreement between assays and the lack of validated normal ranges for IGF-1, 3,4 the same assay should be used in the same patient for serial measurement. 5A random GH measurement was not considered useful in diagnosis because of the lack of a well-defined normal or safe range, although a markedly elevated random GH level is certainly consistent with the disease. Additionally, in subjects with elevated or equivocal serum IGF-1 concentrations, the recent acromegaly guidelines recommended confirmation of the diagnosis with a lack of suppression of GH to less than 1 mcg/l following an oral glucose load. 6 In a patient with signs and symptoms of acromegaly and an elevated IGF-1 value, an oral glucose tolerance test (OGTT) may not be necessary for diagnosis. In the setting of a clinical suspicion but discordant values, such as an elevated IGF-1 and normal GH value (i.e., suppressible with OGTT), the subject likely has early stage acromegaly. 7After diagnosis of acromegaly, a magnetic resonance imaging (MRI) scan of the sella should be obtained to determine tumor size, location, and invasiveness. Visual field testing is performed if the tumor is touching or compressing the optic chiasm. A thorough ophthalmologic examination should be performed if the patient describes diplopia and the tumo...

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Clinical use of cabergoline as primary and adjunctive treatment for acromegaly

Cited by 50 publications

References 24 publications

Cabergoline treatment in acromegaly: cons

Cabergoline treatment in acromegaly: cons

An update on the treatment of acromegaly

Diagnosis and Management of Acromegaly in 2014 (Update from 2012)

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