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Prospective Study of High-Dose Cabergoline Treatment of Prolactinomas in 150 Patients

Department of Medicine II (M.O., N.M., R.M., T.S., K.T.), Institute of Clinical Endocrinology, and Department of Neurosurgery (T.K., K.A., O.K., T.H.), Tokyo Women’s Medical University, Tokyo162-8666, Japan

Address all correspondence and requests for reprints to: Masami Ono, M.D., Department of Medicine II, Institute of Clinical Endocrinology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. E-mail: miki-masa{at}abox3.so-net.ne.jp.

Context: Cabergoline fails to normalize hyperprolactinemia in a considerable proportion of prolactinomas, especially macroadenomas.

Objective: We examined the effect of individualized high-dose cabergoline treatment on hyperprolactinemia in prolactinomas.

Patients: The study included 122 women and 28 men (93 microadenomas and 57 macroadenomas). Forty-seven had undergone transsphenoidal surgery. According to the preceding medical treatment, the participants were separated into untreated (group U; n = 60), intolerant (group I; n = 64), and resistant (group R; n = 26) groups.

Interventions: We promptly increased cabergoline dose on the basis of individual prolactin levels. Length of treatment was 1 yr.

Results: Cabergoline normalized hyperprolactinemia in all patients except one. The proportion of prolactin normalization in both groups U and I was 83% at 3 months and 95% at 6 months. By contrast, that in group R was 35% at 3 months and 58% at 6 months. Mean cabergoline dose in milligrams per week at the time of prolactin normalization was 2.0 ± 0.3 in group U, 0.9 ± 0.1 in group I, and 5.2 ± 0.6 in group R. Prolactin normalization rate at the 3 mg/wk dose was 84% overall but only 35% in group R. Serum progesterone or testosterone levels, diminished in 122 women or 16 men, respectively, were recovered in all except one resistant and four postmenopausal or panhypopituitary patients.

Conclusion: Individualized high-dose cabergoline treatment can normalize hyperprolactinemia and hypogonadism in nearly all prolactinomas irrespective of tumor size or preceding treatments. Hyperprolactinemia could be controlled in poor responders within 1 yr with doses higher than 3 mg/wk.

This article has been cited by other articles:

				M. E. Molitch The Cabergoline-Resistant Prolactinoma Patient: New Challenges J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4643 - 4645. [Full Text] [PDF]