Treatment of Acromegaly with Dopamine Agonists

Jaffe, Craig A.; Barkan, Ariel L.

doi:10.1016/s0889-8529(18)30210-x

Cited by 197 publications

(86 citation statements)

References 150 publications

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“…SA remains the mainstay of medical treatment with oral DA as a second-line agent currently advocated with coexisting hyperprolactinaemia. There are, however, limited data on the therapeutic efficacy of combined use of SA and DA therapy (20). In a recent prospective study Cozzi et al demonstrated the efficacy of the addition of DA to SA therapy (21).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly

et al. 2005

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Background: The excess mortality and morbidity associated with acromegaly are secondary to prolonged elevation of GH and IGF-I. Vigorous control of these biochemical parameters results in improved morbidity and mortality. Somatostatin analogues (SAs) allow adequate control of GH and IGF-I in approximately 65% of subjects, leaving a significant cohort uncontrolled. Dopamine agonists (DAs), a cheap alternative to SAs, allow control of GH and IGF-I in less than 20% of patients with acromegaly. Aims: To assess the effectiveness of adding DA therapy to SA in the biochemical control of acromegaly. Subjects: One hundred and twenty cases from the Sheffield Acromegaly Register were reviewed; 24 (20%) did not require medical treatment following pituitary surgery alone; 16 (13%) had safe GH levels following surgery and radiotherapy; and 58 (48%) required medical treatment despite having had surgery, radiotherapy or both. The remaining 22 (18%) received only medical treatment. Methods: In nine subjects a DA (three bromocriptine, six cabergoline) was added to an SA to control active disease. GH day curves and IGF-I levels were compared before and after the addition of a DA to existing SA treatment. All were on stable maximum-dose treatment with an SA, with inadequate biochemical control prior to addition of DA therapy. Mean duration of treatment on a DA before biochemical assessments were made was 10.3 months. Six subjects had previously been treated with either transsphenoidal surgery, radiotherapy or both. In three subjects SA was the primary therapy. Results: All subjects exhibited a fall in median GH and IGF-I levels. Introduction of a DA resulted in a 36.1% reduction in median GH levels (8.3 vs 5.3 mIU/l; P ¼ 0.008) on a GH day curve and a 35.2% reduction in IGF-I levels (387.2 vs 251.0 mg/l; P ¼ 0.018). Only four subjects had elevated prolactin levels prior to the addition of a DA (. 368 mIU/l). Conclusion: Addition of DAs to SAs is of benefit in the biochemical control of acromegaly and should be considered in those inadequately controlled. Furthermore, the beneficial effects of DAs occur even when pre-treatment prolactin levels are within the normal range.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly

et al. 2005

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“…Difficulties lie in that the same response is not observed for GH and insulin-like growth factor 1 (IGF-1) in a marked proportion of patients (4)(5)(6), with persistence of hypersecretion of these hormones. Since biochemically uncontrolled acromegaly, even when asymptomatic, is associated with higher morbidity and mortality (2), the identification of these cases is important.…”

Section: Introductionmentioning

confidence: 99%

Biochemical acromegaly in patients with prolactinoma during treatment with dopaminergic agonists

Rosário

Purisch

2010

Arq Bras Endocrinol Metab

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Objective: To evaluate the frequency of subclinical acromegaly (in the absence of clinical phenotype but biochemically uncontrolled) in patients with prolactinoma during treatment with dopaminergic agonists. Subjects and methods: One hundred twenty one patients without a phenotype suggestive of acromegaly were studied. Results: Initially, the laboratory diagnosis of acromegaly was unequivocal (elevated IGF-1 for gender and age with nadir GH > 1 µg/L) in two patients, and likely (elevated IGF-1 with nadir GH > cut-off but < 1 µg/L) in another patient. In two other patients, this diagnosis was possible (normal IGF-1 with nadir GH > 1 µg/L). Repetition of the tests 6 months after withdrawal of the dopaminergic agonist confirmed the diagnosis of subclinical acromegaly (elevated IGF-1 for gender and age with nadir GH > 1 µg/L) in these 5 patients. False-positive results were excluded in all cases. Conclusion: In patients with prolactinomas, acromegaly should be investigated not only in cases with a clinical phenotype. Arq Bras Endocrinol Metab. 2010;54(6):546-9 Keywords Acromegaly; prolactinoma; growth hormone; IGF-1 RESUMO Objetivo: Avaliar a frequência de acromegalia subclínica (na ausência de fenótipo clínico, mas bioquimicamente não controlada) em pacientes com prolactinoma em tratamento com agonistas dopaminérgicos. Sujeitos e métodos: Cento e vinte e um pacientes sem fenótipo de acromegalia foram estudados. Resultados: Inicialmente, o diagnóstico laboratorial de acromegalia foi inequívoco (IGF-1 elevado para sexo e idade com nadir do GH > 1 µg/L) em dois pacientes, e provável (IGF-1 elevado com nadir do GH > valor de corte ensaio-específico mas < 1 µg/L) em outro paciente. Em outros dois, esse diagnóstico foi possível (IGF-1 normal com nadir do GH > 1 µg/L). A repetição dos testes seis meses após a suspensão dos agonistas dopaminérgicos confirmou o diagnóstico de acromegalia subclínica (IGF-1 elevado para sexo e idade com nadir do GH > 1 µg/L) em cinco desses pacientes. Os resultados falso-positivos foram excluídos em todos os casos. Conclusão: Em pacientes com prolactinomas, a acromegalia deveria ser investigada não apenas nos casos com fenótipo clínico. Arq Bras Endocrinol Metab. 2010;54(6):546-9 Descritores Acromegalia; prolactinoma; hormônio de crescimento; IGF-1

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“…Before octreotide was introduced, bromocriptine was the only available medical therapy for acromegaly (26). Bromocriptine was shown to suppress random growth hormone levels to !10 mg/l in 50% of patients, but IGF-I levels normalise in only 10% of treated patients and !20% of GH-secreting tumours were reported to reduce in size (26). The subjective clinical symptoms improved in 70-90% of patients (26).…”

Section: Gh-secreting Tumoursmentioning

confidence: 99%

“…Bromocriptine was shown to suppress random growth hormone levels to !10 mg/l in 50% of patients, but IGF-I levels normalise in only 10% of treated patients and !20% of GH-secreting tumours were reported to reduce in size (26). The subjective clinical symptoms improved in 70-90% of patients (26). Quinagolide, another dopaminergic agent, at a dose of 0.3-0.6 mg/day suppressed GH and IGF-I levels to normal in about 30% of the treated patients (16).…”

Section: Gh-secreting Tumoursmentioning

confidence: 99%

Combined therapy of somatostatin analogues and dopamine agonists in the treatment of pituitary tumours

Colao

Filippella²,

Pivonello

et al. 2007

eur j endocrinol

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Pituitary tumours express both somatostatin and dopamine receptors. Medical treatment with somatostatin analogues is a cornerstone of GH-and TSH-secreting tumours, while treatment with dopamine agonists is a cornerstone of prolactin-secreting tumours. Dopamine agonists have also demonstrated some efficacy in patients with GH-and TSH-secreting adenomas. Neither ACTHsecreting nor clinically non-functioning tumours have a well-established medical treatment. Nevertheless, some recent results have indicated a potential usefulness of the dopamine agonist cabergoline in patients with pituitary-dependent Cushing's disease. Combination treatment with both somatostatin analogues and dopamine agonists has been poorly investigated. Some studies conducted in small series have documented an additive effect of both drugs in patients with GH-secreting adenomas. Of mention is that none of the studies were randomised and cross-sectional so that the results should be confirmed by other well-designed studies. No data are available in other pituitary tumour histotypes. Preliminary observations in patients with clinically non-functioning adenomas are very promising.

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Treatment of Acromegaly with Dopamine Agonists

Cited by 197 publications

References 150 publications

Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly

Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly

Biochemical acromegaly in patients with prolactinoma during treatment with dopaminergic agonists

Combined therapy of somatostatin analogues and dopamine agonists in the treatment of pituitary tumours

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