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Effect of Different Dopaminergic Agents in the Treatment of Acromegaly

Department of Molecular and Clinical Endocrinology and Oncology (A.C., D.F., P.M., A.D.S., G.C., F.S., B.M., G.L.) and Department of Radiology (S.C.), University Federico II, Naples, 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, via S. Pansini 5, 80131 Naples, Italy.

Medical treatment of acromegaly with dopamine agonists possesses 2 main advantages: the oral administration and the low costs. In this study, we reported on the results of chronic treatments with quinagolide (CV 205–502), cabergoline (CAB) and long-acting depot preparation of bromocriptine (BRC-LAR) in 34 acromegalics. Patients were divided into three groups on the basis of different treatment: CV 205–502 given to 16 patients at the dose of 0.3–0.6 mg/day for 6 months; CAB given to 11 patients at the dose of 1.0–2.0 mg weekly for 6 months; and BRC-LAR injected into 7 patients at the dose of 100 mg/month for 6–12 months. Basal and oral glucose tolerance test-stimulated serum GH levels, basal and TRH-stimulated PRL levels, plasma insulin-like growth factor I (IGF-I) levels, computed tomography scan, and/or magnetic resonance imaging were assessed before and quarterly during treatments. The chronic administration of CV 205–502, CAB, and BRC-LAR caused a significant decrease of circulating GH, IGF-I, and PRL levels (P < 0.005). Normalization of circulating GH and IGF-I levels was obtained in 7 of 16 (43.8%) patients treated with CV 205–502. Serum GH response to oral glucose tolerance test (oGTT) significantly improved (P < 0.005), and PRL levels were significantly suppressed during treatments. No correlation was found between basal and TRH-stimulated PRL levels and GH suppression during different therapies. Immunohistochemical staining revealed 19 GH-positive and 10 GH+PRL-positive adenomas. A significant association was found between GH/PRL staining and responsiveness to chronic treatments (² = 7.985, P < 0.005). Three patients had significant adenoma shrinkage. Slight nausea and hypotension, which spontaneously disappeared within therapy progression, were referred by 5/16 patients during CV 205–502 and 2/7 during BRC-LAR.

The results of this study indicate that CAB and BRC-LAR cannot be considered as useful medical approaches for acromegalics, whereas CV 205–502 normalized circulating GH and IGF-I levels in 47.8% of patients.

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