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Cabergoline in the Treatment of Acromegaly: A Study in 64 Patients

Department of Endocrinology, University Hospital (R.A., K.V.A.), and Middelheim Hospital (J.V., C.M.), Antwerp; Hôpital Saint-Luc (D.M.), Brussels; Onze Lieve Vrouw Hospital (F.N.), Aalst; Salvator Hospital (J.-L.C.), Hasselt; and Centre Hospitalier Universitaire (A.B.), Liège, Belgium

Address all correspondence and requests for reprints to: Dr. Roger Abs, Department of Endocrinology, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, B-2650 Belgium.

Cabergoline is a new, long acting, dopamine agonist that is more effective and better tolerated than bromocriptine in patients with hyperprolactinemia. Because dopamine agonists still have a place in the medical management of acromegaly, cabergoline might be a useful treatment.

We, therefore, evaluated the effect of long term administration of cabergoline in a large group of unselected acromegalic patients. Sixty-four patients were included in a multicenter, prospective, open labeled study. A subgroup of 16 patients had GH-/PRL-cosecreting pituitary adenomas. Cabergoline was started at a dose of 1.0 mg/week and was gradually increased until normalization of plasma insulin-like growth factor I (IGF-I) levels, occurrence of unacceptable side-effects, or a maximal weekly dose of 3.5 mg (7.0 mg in 1 case) was reached.

Treatment with cabergoline suppressed plasma IGF-I below 300 µg/L in 39% of cases and between 300–450 µg/L in another 28%. With pretreatment plasma IGF-I concentrations less than 750 µg/L, a suppression of IGF-I below 300 µg/L was obtained in 53% of cases, and a suppression between 300–450 µg/L was obtained in another 32%. By contrast, with pretreatment plasma IGF-I concentrations above 750 µg/L, only 17% of cases showed a suppression of IGF-I below 300 µg/L, and there was IGF-I suppression between 300–450 µg/L in another 21%. In GH-/PRL-cosecreting adenomas, 50% of cases suppressed plasma IGF-I levels below 300 µg/L, and another 31% did so between 300–450 µg/L, in contrast to only 35% and 27%, respectively, in GH-secreting adenomas.

Similar results were obtained concerning the secretion of GH. Tumor shrinkage was demonstrated in 13 of 21 patients, with a mass reduction by more than half in 5 GH-/PRL-cosecreting adenomas. Except for slight gastrointestinal discomfort and orthostatic hypotension in a few patients at the beginning of therapy, cabergoline treatment was well tolerated. Only 2 patients stopped medication because of nausea. The weekly dose of cabergoline ranged between 1.0–1.75 mg. A further increase in the dose was only effective in 1 GH-/PRL-cosecreting adenoma.

The results of this study suggest that cabergoline is an effective, well tolerated therapy that should be considered in the management of acromegaly, especially if the pituitary adenoma cosecretes GH and PRL or if pretreatment plasma IGF-I levels are below 750 µg/L.

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