Treatment of macroprolactinoma with cabergoline: a study of 85 patients.

Abstract

OBJECTIVE:

Cabergoline is now established as an effective and well-tolerated treatment for prolactinoma. However, there are relatively few published data on the treatment of macro-, as opposed to micro-, prolactinoma. We have therefore reviewed the efficiency and safety of cabergoline in the treatment of patients with prolactin-secreting macroadenomas treated on a compassionate basis.

STUDY DESIGN AND PATIENTS:

Eighty-five patients with prolactin-secreting macroadenomas were treated with cabergoline 0.25 to 10.5 mg per week (median 1 mg) given to one to seven doses. Treatment durations ranged between 3 months and 8 years. Sixty-five patients (32 intolerant, 16 resistant) had been treated previously with other dopamine agonists. Pretreatment prolactin levels ranged between 80 and 8300 micrograms/I and tumour maximum diameters were between 11 and 42 mm.

MEASUREMENTS:

Serum prolactin, visual fields if initially abnormal, occurrence of menses or return of libido and potency, blood chemistry and adverse events were assessed at 1 month and then at 3-month intervals during treatment. Pituitary computed tomography or magnetic resonance imaging was usually repeated at 3 months and 1 year, then yearly, in most patients (n = 62).

RESULTS:

Normalization of prolactin levels was achieved in 52 patients (61.2%) and a prolactin decrease of at least 75% of pretreatment values occurred in 24 others (28.2%). Of the 20 de novo patients, 17 had prolactin normalized and the remainder had at least 75% reduction. Disappearance of tumour image was found in eight of 62 evaluable patients (12.9%) and reduction of the largest diameter by at least 25% in another 33 (53.2%), with an overall success rate of 66.1%; among the 17 evaluable de novo patients the success rate was 82.3%. Fifteen of 21 patients who failed to show tumour shrinkage had previously demonstrated resistance/intolerance to other prolactin-lowering treatments. Of the 12 patients with visual field defects at baseline, six normalized and two showed an improvement. Menses resumed during cabergoline treatment in 79.5% of premenopausal women. Restoration of potency was reported by seven of eight evaluable men. Adverse events were recorded in 24.7% of cases, four of whom (4.7%) discontinued treatment.

CONCLUSIONS:

Although the present data were not obtained in a formal study we conclude that cabergoline is an effective and well-tolerated treatment for macroprolactinoma patients.

• Authors: C I Ferrari, R Abs, J S Bevan, G Brabant, E Ciccarelli, T Motta, M Mucci, M Muratori, L Musatti, G Verbessem, M F Scanlon
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 46 Issue 4 Pg. 409-13 (Apr 1997) ISSN: 0300-0664 [Print] England
• PMID: 9196602 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antineoplastic Agents
• Dopamine Agonists
• Ergolines
• Prolactin
• Cabergoline

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Agents (therapeutic use)
• Cabergoline
• Dopamine Agonists (therapeutic use)
• Ergolines (therapeutic use)
• Female
• Humans
• Infertility, Male (drug therapy, etiology)
• Male
• Menstruation Disturbances (drug therapy, etiology)
• Middle Aged
• Pituitary Neoplasms (complications, drug therapy, pathology)
• Prolactin (blood)
• Prolactinoma (complications, drug therapy, pathology)