This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colao, A. Articles by Lombardi, G. Search for Related Content PubMed PubMed Citation Articles by Colao, A. Articles by Lombardi, G.

Long-Term and Low-Dose Treatment with Cabergoline Induces Macroprolactinoma Shrinkage

Department of Molecular and Clinical Endocrinology and Oncology (A.C., A.D.S., M.L.L., F.S., G.F., R.P., B.M., G.L.), Radiology (S.C.), and Unit of Pharmacology, Department of Neurosciences (M.C., L.A.), Federico II University of Naples, 80131 Napoli, Italy

Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, via S. Pansini 5, 80131 Napoli, Italy.

Cabergoline (CAB), a long-lasting dopamine-agonist, specific for the D₂ receptor, is effective in normalizing serum PRL levels in most patients with microprolactinoma or idiopathic hyperprolactinemia. Because few data are presently available on the effects of CAB treatment in macroprolactinomas, the aim of this open-label study was to investigate whether this drug was effective in producing tumor shrinkage, as well as in normalizing PRL levels.

Twenty-three patients with macroprolactinoma entered this study: 15 patients had had no treatment, whereas the remaining 8 patients had been previously treated with bromocriptine, which was withdrawn because of intolerance. Three of 23 patients had undergone unsuccessful surgery. Pretreatment serum PRL levels ranged from 100-3860 µg/L.

CAB was administered at a dose of 0.5–3 mg once or twice a week for 12–24 months. Magnetic resonance imaging (MRI) scans were performed before and 3, 6, 12, and 24 months after the beginning of treatment, to evaluate tumor shrinkage, defined as a decrease of at least 80% of baseline tumor volume.

After 3–6 months of treatment with a low dose (0.5–1 mg/week), serum PRL levels normalized in 18 patients. In the remaining 5 patients, whose serum PRL levels were not normalized, the dose was increased to 2–3 mg/week. This schedule caused the normalization of PRL levels in 1 patient, whereas in the remaining 4 patients, PRL levels were reduced to 30–82 µg/L. A tumor volume reduction greater than 80% at MRI occurred in 14 of 23 patients (61%) after CAB treatment (from 2609.4 ± 534.7 to 530.1 ± 141.3 mm³ at the 12–24th month follow-up, P < 0.001). A volume reduction of 41.8 ± 3.4% was already evident after 3 months (1436 ± 285.9 mm³; P < 0.001). The complete disappearance of the tumor mass at MRI occurred after 6 months of treatment with CAB in 1 patient, and in 5 patients after 1 yr of treatment. An improvement of visual field defects was obtained in 9 of the 10 patients presenting visual impairment before CAB treatment. The drug was tolerated well by all patients. Only 1 patient experienced mild nausea, which disappeared spontaneously after the 2nd day of treatment.

Long-term, a low dose of the D₂ receptor agonist CAB significantly reduced tumor volume and normalized serum PRL levels in a great majority of patients bearing macroprolactinoma. This treatment met with excellent patient compliance. This study suggests that CAB can be used as a first choice drug treatment in macroprolactinomas, as already shown for microprolactinomas and idiopathic hyperprolactinemia.

This article has been cited by other articles:

				M. Ono, N. Miki, T. Kawamata, R. Makino, K. Amano, T. Seki, O. Kubo, T. Hori, and K. Takano Prospective Study of High-Dose Cabergoline Treatment of Prolactinomas in 150 Patients J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4721 - 4727. [Abstract] [Full Text] [PDF]

				E. R. Smith, J. Loeffler, M. Misra, S. R. Pomerantz, A. Stemmer-Rachamimov, and M. D. Post Case 37-2008 -- A 17-Year-Old Boy with a Pituitary Tumor and Skull Abnormalities N. Engl. J. Med., November 27, 2008; 359(22): 2367 - 2377. [Full Text] [PDF]

				A. Colao, M. Galderisi, A. Di Sarno, M. Pardo, M. Gaccione, M. D'Andrea, E. Guerra, R. Pivonello, G. Lerro, and G. Lombardi Increased Prevalence of Tricuspid Regurgitation in Patients with Prolactinomas Chronically Treated with Cabergoline J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3777 - 3784. [Abstract] [Full Text] [PDF]

				C. Alvarez, I. Alonso-Muriel, G. Garcia, J. Crespo, J. Bellver, C. Simon, and A. Pellicer Implantation is apparently unaffected by the dopamine agonist Cabergoline when administered to prevent ovarian hyperstimulation syndrome in women undergoing assisted reproduction treatment: a pilot study Hum. Reprod., December 1, 2007; 22(12): 3210 - 3214. [Abstract] [Full Text] [PDF]

				I. Shimon, C. Benbassat, and M. Hadani Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men Eur. J. Endocrinol., February 1, 2007; 156(2): 225 - 231. [Abstract] [Full Text] [PDF]

				M. P. Gillam, M. E. Molitch, G. Lombardi, and A. Colao Advances in the Treatment of Prolactinomas Endocr. Rev., August 1, 2006; 27(5): 485 - 534. [Abstract] [Full Text] [PDF]

				A. Colao, G. Vitale, P. Cappabianca, F. Briganti, A. Ciccarelli, M. De Rosa, S. Zarrilli, and G. Lombardi Outcome of Cabergoline Treatment in Men with Prolactinoma: Effects of a 24-Month Treatment on Prolactin Levels, Tumor Mass, Recovery of Pituitary Function, and Semen Analysis J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1704 - 1711. [Abstract] [Full Text] [PDF]

				M. De Rosa, S. Zarrilli, G. Vitale, C. Di Somma, F. Orio, L. Tauchmanova', G. Lombardi, and A. Colao Six Months of Treatment with Cabergoline Restores Sexual Potency in Hyperprolactinemic Males: An Open Longitudinal Study Monitoring Nocturnal Penile Tumescence J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 621 - 625. [Abstract] [Full Text] [PDF]

				A. Colao, A. Di Sarno, P. Cappabianca, C. Di Somma, R. Pivonello, and G. Lombardi Withdrawal of Long-Term Cabergoline Therapy for Tumoral and Nontumoral Hyperprolactinemia N. Engl. J. Med., November 20, 2003; 349(21): 2023 - 2033. [Abstract] [Full Text] [PDF]

				M. P. Gillam, S. Middler, D. J. Freed, and M. E. Molitch The Novel Use of Very High Doses of Cabergoline and a Combination of Testosterone and an Aromatase Inhibitor in the Treatment of a Giant Prolactinoma J. Clin. Endocrinol. Metab., October 1, 2002; 87(10): 4447 - 4451. [Abstract] [Full Text] [PDF]

				A. Di Sarno, M. L. Landi, P. Cappabianca, F. Di Salle, F. W. Rossi, R. Pivonello, C. Di Somma, A. Faggiano, G. Lombardi, and A. Colao Resistance to Cabergoline as Compared with Bromocriptine in Hyperprolactinemia: Prevalence, Clinical Definition, and Therapeutic Strategy J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5256 - 5261. [Abstract] [Full Text] [PDF]

				J. J. Pinzone, L. Katznelson, D. C. Danila, D. K. Pauler, C. S. Miller, and A. Klibanski Primary Medical Therapy of Micro- and Macroprolactinomas in Men J. Clin. Endocrinol. Metab., September 1, 2000; 85(9): 3053 - 3057. [Abstract] [Full Text]

				A. Colao, A. Di Sarno, M. L. Landi, F. Scavuzzo, P. Cappabianca, R. Pivonello, R. Volpe, F. Di Salle, S. Cirillo, L. Annunziato, et al. Macroprolactinoma Shrinkage during Cabergoline Treatment Is Greater in Naive Patients Than in Patients Pretreated with Other Dopamine Agonists: A Prospective Study in 110 Patients J. Clin. Endocrinol. Metab., June 1, 2000; 85(6): 2247 - 2252. [Abstract] [Full Text]

				P. U. Freda, C. I. Andreadis, A. G. Khandji, M. Khoury, J. N. Bruce, T. P. Jacobs, and S. L. Wardlaw Long-Term Treatment of Prolactin-Secreting Macroadenomas with Pergolide J. Clin. Endocrinol. Metab., January 1, 2000; 85(1): 8 - 13. [Full Text]

				J. Verhelst, R. Abs, D. Maiter, A. van den Bruel, M. Vandeweghe, B. Velkeniers, J. Mockel, G. Lamberigts, P. Petrossians, P. Coremans, et al. Cabergoline in the Treatment of Hyperprolactinemia: A Study in 455 Patients J. Clin. Endocrinol. Metab., July 1, 1999; 84(7): 2518 - 2522. [Abstract] [Full Text]

				S A M Saeed, O A Farooqi, B Panayiotou, and T C Harvey Reversible confusional state in an elderly man Postgrad. Med. J., June 1, 1999; 75(884): 365 - 367. [Full Text]