Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment

Annamaria Colao, Antonella Di Sarno, Francesca Sarnacchiaro, Diego Ferone, Gianfranco Di Renzo, Bartolomeo Merola, Lucio Annunziato, Gaetano Lombardi

Research output: Contribution to journalArticle

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Abstract

Cabergoline (CAB), a new, potent, and long-lasting PRL-lowering agent, was shown to be effective in tumoral hyperprolactinemia. The aim of this study was to investigate the effectiveness of CAB in patients with prolactinoma proven to be resistant to bromocriptine (BRC) and quinagolide (CV 205-502). Twenty seven patients (19 macro- and 8 microprolactinomas) were treated with CAB at a weekly dose of 0.5-3 mg for 3-22 months. All patients were previously shown to be resistant to BRC, and 20 of them were resistant to CV 205-502 as well. Basal serum PRL levels before CAB treatment ranged from 108-3500 μg/L in macroprolactinomas and from 64-205 μg/L in microprolactinomas. Gonadal failure was present in all patients, whereas symptoms of tumor expansion, such as visual field defects and headache, were present in 10 of 27 patients. Eight macroprolactinomas had previously undergone surgery and/or radiotherapy. CAB treatment normalized serum PRL levels in 15 of 19 macroprolactinomas and in all 8 microprolactinomas. In 3 of the remaining 4 patients it caused a notable decrease in prolactinemia (89%, 80.5%, and 68.7% of the baseline). Only 1 patient was withdrawn from CAB therapy after 3 months at the weekly dose of 2 mg due to the absence of any significant clinical, hormonal, or radiological improvement. Gonadal function was restored in 18 of 27 patients, galactorrhea disappeared in 5 of 6 women, and headache improved in 7 of 8 patients. A significant tumor shrinkage was detected by computed tomography and/or magnetic resonance imaging in 9 macroprolactinomas and 4 microprolactinomas. CAB was well tolerated by all patients, except 6 who referred slight and short-lasting nausea, postural hypotension, abdominal pain, dizziness, and sleepiness at the beginning of treatment. In particular, CAB was well tolerated by 19 patients previously shown to be poorly tolerant to BRC and CV 205-502. In conclusion, CAB may represent, at the moment, the only successful therapy for prolactinoma-bearing patients resistant to BRC and CV 205-502, as it normalized PRL levels in 22 of 27 patients, reduced tumor size in 13 of 27 patients, and improved clinical symptoms in 25 of 27 patients in the present study.

Original languageEnglish
Pages (from-to)876-883
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume82
Issue number3
DOIs
Publication statusPublished - 1997

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Prolactinoma
Dopamine Agonists
Bromocriptine
Tumors
Therapeutics
Bearings (structural)
cabergoline
Radiotherapy
Headache
Magnetic resonance
Surgery
Tomography
Macros
Galactorrhea
Neoplasms
Orthostatic Hypotension
Hyperprolactinemia
quinagolide
Imaging techniques
Dizziness

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. / Colao, Annamaria; Di Sarno, Antonella; Sarnacchiaro, Francesca; Ferone, Diego; Di Renzo, Gianfranco; Merola, Bartolomeo; Annunziato, Lucio; Lombardi, Gaetano.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 82, No. 3, 1997, p. 876-883.

Research output: Contribution to journalArticle

Colao, Annamaria ; Di Sarno, Antonella ; Sarnacchiaro, Francesca ; Ferone, Diego ; Di Renzo, Gianfranco ; Merola, Bartolomeo ; Annunziato, Lucio ; Lombardi, Gaetano. / Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. In: Journal of Clinical Endocrinology and Metabolism. 1997 ; Vol. 82, No. 3. pp. 876-883.
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abstract = "Cabergoline (CAB), a new, potent, and long-lasting PRL-lowering agent, was shown to be effective in tumoral hyperprolactinemia. The aim of this study was to investigate the effectiveness of CAB in patients with prolactinoma proven to be resistant to bromocriptine (BRC) and quinagolide (CV 205-502). Twenty seven patients (19 macro- and 8 microprolactinomas) were treated with CAB at a weekly dose of 0.5-3 mg for 3-22 months. All patients were previously shown to be resistant to BRC, and 20 of them were resistant to CV 205-502 as well. Basal serum PRL levels before CAB treatment ranged from 108-3500 μg/L in macroprolactinomas and from 64-205 μg/L in microprolactinomas. Gonadal failure was present in all patients, whereas symptoms of tumor expansion, such as visual field defects and headache, were present in 10 of 27 patients. Eight macroprolactinomas had previously undergone surgery and/or radiotherapy. CAB treatment normalized serum PRL levels in 15 of 19 macroprolactinomas and in all 8 microprolactinomas. In 3 of the remaining 4 patients it caused a notable decrease in prolactinemia (89{\%}, 80.5{\%}, and 68.7{\%} of the baseline). Only 1 patient was withdrawn from CAB therapy after 3 months at the weekly dose of 2 mg due to the absence of any significant clinical, hormonal, or radiological improvement. Gonadal function was restored in 18 of 27 patients, galactorrhea disappeared in 5 of 6 women, and headache improved in 7 of 8 patients. A significant tumor shrinkage was detected by computed tomography and/or magnetic resonance imaging in 9 macroprolactinomas and 4 microprolactinomas. CAB was well tolerated by all patients, except 6 who referred slight and short-lasting nausea, postural hypotension, abdominal pain, dizziness, and sleepiness at the beginning of treatment. In particular, CAB was well tolerated by 19 patients previously shown to be poorly tolerant to BRC and CV 205-502. In conclusion, CAB may represent, at the moment, the only successful therapy for prolactinoma-bearing patients resistant to BRC and CV 205-502, as it normalized PRL levels in 22 of 27 patients, reduced tumor size in 13 of 27 patients, and improved clinical symptoms in 25 of 27 patients in the present study.",
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AU - Colao, Annamaria

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AU - Di Renzo, Gianfranco

AU - Merola, Bartolomeo

AU - Annunziato, Lucio

AU - Lombardi, Gaetano

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