Velázquez-Chávez FJ, Tapia-González MA, González-Bárcena D

Language: Spanish
References: 13
Page: 173-177
PDF size: 91.16 Kb.

ABSTRACT

Background: Dopaminergic agonists are the treatment of choice for prolactinomas with bromocriptine being the primary agent used. There is a group of patients who are not responders to such therapy or have severe side effects (resistant or intolerant to bromocriptine, respectively). We undertook this study to evaluate the response to the administration of cabergoline in patients intolerant or resistant to bromocriptine. Methods: Twenty seven patients (25 females and 2 males) were recruited with prolactin-pituitary tumors, obtaining basal serum prolactin samples and again each month up to 3 months. We recorded signs associated with hyperprolactinemia and secondary effects of cabergoline. The initial dose was 0.25 mg twice weekly during the first week, with an increase to 0.5 mg twice weekly from the second week until the conclusion of the study. Statistical analysis included Shapiro-Wilk, Kruskal-Wallis and ANOVA tests. Results: Twenty two patients had microadenomas and five had macroadenomas. In the intolerant group (n = 11), the initial prolactin value of 61.45 ± 19.82 decreased by the third month to 4.94 ± 1.79 (p ‹0.024). In the resistant group (n = 16), basal prolactin values were 119.53 ± 11.52. In 15 of these patients, the prolactin value significantly decreased to 12.95 ±3.66 ng/ ml (p ‹0.005) by the third month of treatment. In both groups the signs related to hyperprolactinemia significantly improved, with a low incidence of secondary effects due to cabergoline. Conclusions: Cabergoline is useful in most patients considered as intolerant or resistant to bromocriptine.

REFERENCES

1. Biller BM, Luciano A, Crosignani PG, Molitch M, Olive D, Rebor R, et al. Guidelines for the diagnosis and treatment of hyperprolactinemia. J Reprod Med 1999;44:1075-1084.

2. Luciano A. Clinical presentation of hyperprolactinemia. J Reprod Med 1999;44(suppl 12):1085-1090.

3. Crosignani PG. Management of hyperprolactinemia in infertility. J Reprod Med 1999;44(suppl 12):1116-1120.

4. Faglia G. Epidemiology and pathogenesis of pituitary adenomas. Acta Endocrinol 1993;12(suppl 1):1-5.

5. Shimon I, Melmed S. Management of pituitary tumors. Ann Intern Med 1998;129:472-483.

6. Davis JRE, Farell WE, Clayton RN. Pituitary tumors. Reproduction 2001;121:363-371.

7. Cunnah D, Besser G. Management of prolactinomas. Clin Endocrinol 1991;34:231-235.

8. Molitch M, Thorner M, Wilson C. Management of prolactinomas. J Clin Endocrinol Metab 1997;82:996-1000.

9. Colao A, Annunziato L, Lombardi G. Treatment of prolactinomas. Ann Med 1998;30:425-429.

10. Emilien G, Maloteaux JM, Geurts M, Hoogenberg K, Cragg S. Dopamine receptorsphysiological understanding to therapeutic intervention potential. Pharmacol Therapeut 1999;84:133-156.

11. 11.Vance M, Evans W, Thorner M. Drugs five years later. Bromocriptine. Ann Intern Med 1984;100:78-91.

12. Di Sarno A, Laudi ML, Cappabianca P, Di Salle F, Rossi FW, Pivonello R, et al. Resistance to cabergoline as compared with bromocriptine in hyperprolactinemia: prevalence, clnical definition, and therapeutic strategy. J Clin Endocrinol Metab 2001;86:5256-5261.

13. Molitch ME. Pharmacologic resistance in prolactinoma patients. Pituitary 2005;8:43-52.