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Horm Metab Res 2022; 54(10): 664-670
DOI: 10.1055/a-1930-6585
Original Article: Endocrine Care

Effect of Cabergoline Treatment on Disease Control in Acromegaly Patients

Hulya Hacisahinogullari
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Gulsah Yenidunya Yalin
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Ozlem Soyluk Selcukbiricik
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Nurdan Gul
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Bilge Bilgic
2   Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Ayse Kubat Uzum
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Refik Tanakol
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Ferihan Aral
1   Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Abstract

The aim of this study was to evaluate the efficacy of cabergoline in normalizing plasma IGF-I levels in acromegaly patients with elevated IGF-I levels after surgery and/or SRL therapy. Acromegaly patients (n: 143) were evaluated retrospectively. Patients with elevated IGF-I levels after surgery and/or SRLs therapy and a fixed dose of SRLs treatment for the last six months with no history of radiotherapy in the last three years were included in the study (n: 12). Previous treatment regimens, baseline PRL and IGF-I levels (ULNR), sella MRI, and immunohistochemical findings were evaluated. Cabergoline was used as an add on (n: 11) or single medical treatment (n: 1). The median duration of treatment with SRL alone was 12 months (range 6–48 months). The mean IGF-I value before cabergoline therapy was 1.45±0.4 ULNR. The mean cabergoline dose and duration of treatment were 1.55±0.75 mg/week and 9±6.3 months, respectively. IGF-I normalization was only achieved in patients with serum IGF-I concentration<1.5×ULNR before the onset of cabergoline treatment (n: 9). In some of the patients with IGF-I normalization, baseline prolactin levels were normal (n: 3). Immunopositivity for prolactin in adenoma tissue was found in three patients with IGF-I normalization. Cabergoline therapy is effective in the normalization of IGF-I levels even in normoprolactinemic acromegaly patients when IGF-I levels are mildly or moderately elevated during SRL therapy.

Key words

IGF-1 - acromegaly - cabergoline


Publication History

Received: 13 January 2022

Accepted after revision: 15 August 2022

Article published online:
07 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
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  • References

  • 1 Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary 1999; 2: 29-41
    CrossrefPubMedSearch in Google Scholar
  • 2 Burton T, Le Nestour E, Neary M. et al. Incidence and prevalence of acromegaly in a large US health plan database. Pituitary 2016; 19: 262-267
    CrossrefPubMedSearch in Google Scholar
  • 3 Agustsson TT, Baldvinsdottir T, Jonasson JG. et al. The epidemiology of pituitary adenomas in Iceland, 1955-2012: a nationwide population-based study. Eur J Endocrinol 2015; 173: 655-664
    CrossrefPubMedSearch in Google Scholar
  • 4 Gruppetta M, Mercieca C, Vassallo J. Prevalence and incidence of pituitary adenomas: a population based study in Malta. Pituitary 2013; 16: 545-553
    CrossrefPubMedSearch in Google Scholar
  • 5 Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119: 3189-3202
    CrossrefPubMedSearch in Google Scholar
  • 6 Sherlock M, Ayuk J, Tomlinson JW. et al. Mortality in patients with pituitary disease. Endocr Rev 2010; 31: 301-342
    CrossrefPubMedSearch in Google Scholar
  • 7 Mercado M, Gonzalez B, Vargas G. et al. Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab 2014; 99: 4438-4446
    CrossrefPubMedSearch in Google Scholar
  • 8 Holdaway IM, Bolland MJ, Gamble GD. A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. Eur J Endocrinol 2008; 159: 89-95
    CrossrefPubMedSearch in Google Scholar
  • 9 Reid TJ, Jin Z, Shen W. et al. IGF-1 levels across the spectrum of normal to elevated in acromegaly: relationship to insulin sensitivity, markers of cardiovascular risk and body composition. Pituitary 2015; 18: 808-819
    CrossrefPubMedSearch in Google Scholar
  • 10 Katznelson L, Laws ER, Melmed S. et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol Metab 2014; 99: 3933-3951
    CrossrefPubMedSearch in Google Scholar
  • 11 Chen CJ, Ironside N, Pomeraniec IJ. et al. Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir (Wien) 2017; 159: 2193-2207
    CrossrefPubMedSearch in Google Scholar
  • 12 Carmichael JD, Bonert VS, Nuno M. et al. Acromegaly clinical trial methodology impact on reported biochemical efficacy rates of somatostatin receptor ligand treatments: a metaanalysis. J Clin Endocrinol Metab 2014; 99: 1825-1833
    CrossrefPubMedSearch in Google Scholar
  • 13 Colao A, Auriemma RS, Pivonello R. et al. Interpreting biochemical control response rates with first-generation somatostatin analogues in acromegaly. Pituitary 2016; 19: 235-247
    CrossrefPubMedSearch in Google Scholar
  • 14 Brzana J, Yedinak CG, Gultekin SH. et al. Growth hormone granulation pattern and somatostatin receptor subtype 2A correlate with postoperative somatostatin receptor ligand response in acromegaly: a large single center experience. Pituitary 2013; 16: 490-498
    CrossrefPubMedSearch in Google Scholar
  • 15 Potorac I, Petrossians P, Dalyet AF. et al. T2-weighted MRI signal predicts hormone and tumor responses to somatostatin analogs in acromegaly. Endocr Relat Cancer 2016; 23: 871-881
    CrossrefPubMedSearch in Google Scholar
  • 16 Gadelha MR, Bronstein MD, Brue T. et al. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial. Lancet Diabetes Endocrinol 2014; 2: 875-884
    CrossrefPubMedSearch in Google Scholar
  • 17 Lawton NF, Evans AJ, Weller RO. Dopaminergic inhibition of growth hormone and prolactin release during continuous in vitro perifusion of normal and adenomatous human pituitary. J Neurol Sci 1981; 49: 229-239
    CrossrefPubMedSearch in Google Scholar
  • 18 Rocheville M, Lange DC, Kumar U. et al. Receptors for dopamine and somatostatin: formation of heterooligomers with enhanced functional activity. Science 2000; 288: 154-157
    CrossrefPubMedSearch in Google Scholar
  • 19 Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a meta-analysis. J. Clin. Endocrinol Metab 2011; 96: 1327-1335
    CrossrefPubMedSearch in Google Scholar
  • 20 Osamura RY, Kajiya H, Takei M. et al. Pathology of the human pituitary adenomas. Histochem Cell Biol 2008; 130: 495-507
    CrossrefPubMedSearch in Google Scholar
  • 21 Saeger W, Lüdecke DK, Buchfelder M. et al. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 2007; 156: 203-216
    CrossrefPubMedSearch in Google Scholar
  • 22 Abs R, Verhelst J, Maiter D. et al. Cabergoline in the treatment of acromegaly: a study of 64 patients. J Clin Endocrinol Metab 1998; 83: 374-378
    CrossrefPubMedSearch in Google Scholar
  • 23 Vilar L, Azevedo MF, Naves LA. et al. Role of the addition of cabergoline to the management of acromegalic patients resistant to longterm treatment with octreotide LAR. Pituitary 2010; 14: 148-156
    CrossrefPubMedSearch in Google Scholar
  • 24 Mattar P, Alves Martins MR, Abucham J. Short- and long-term efficacy of combined cabergoline and octreotide treatment in controlling IGF-I levels in acromegaly. Neuroendocrinology 2010; 92: 120-127
    CrossrefPubMedSearch in Google Scholar
  • 25 Varlamov EV, McCartney S, Fleseriu M. Functioning pituitary adenomas – current treatment options and emerging medical therapies. Eur Endocrinol 2019; 15: 30-40
    CrossrefPubMedSearch in Google Scholar
  • 26 Rocheville M, Lange DC, Kumar U. et al. Subtypes of the somatostatin receptor assemble as functional homo-heterodimers. J Biol Chem 2000; 275: 7862-7869
    CrossrefPubMedSearch in Google Scholar
  • 27 Maione L, Garcia C, Bouchachi A. et al. No evidence of a detrimental effect of cabergoline therapy on cardiac valves in patients with acromegaly. J Clin Endocrinol Metab 2012; 97: 1714-1719
    CrossrefPubMedSearch in Google Scholar
  • 28 Barake M, Klibanski A, Tritos NA. Management of endocrine disease: mpulse control disorders in patients with hyperpolactinemia treated with dopamine agonists: how much should we worry?. Eur J Endocrinol 2018; 179: 287-296
    CrossrefPubMedSearch in Google Scholar