Cabergoline in acromegaly: a renewed role for dopamine agonist treatment?
OBJECTIVE
Eighteen active acromegalics entered a prospective open study with cabergoline (CAB), a dopaminergic drug much more potent than bromocriptine (Br).


METHODS
CAB was administered for 6 months at doses ranging between 0.5 mg twice weekly and 0.5 mg/day. Clinical-anamnestic characteristics of the patients were: (i) sensitivity to dopamine agonist drugs (10 patients); (ii) resistance to somatostatin analogs (SAs) (8 patients): (iii) intolerance to SA (3 patients). In 2 patients marked hyperprolactinemia was present.


RESULTS
Basal GH was 6.6 microg/l (2.2-50) (median (range)), and on treatment it was 3.5 microg/l (1.2-34) (P=0.013). The corresponding IGF-I values were 720 microg/l (410-1438) and 375 microg/l (167-1260) respectively (P=0.00001). Individual GH levels decreased below 2 microg/l in 5 patients, and between 2 and 5 microg/l in another 5 patients. IGF-I levels were suppressed below 50% of baseline in 8 patients and normal age-adjusted IGF-I values were reached in 5 patients (27% of the series). The retrospective comparison with previous chronic treatment with Br in the 10 suitable patients showed a greater effectiveness of CAB (IGF-I decrease on CAB treatment, 46.8%, on Br treatment, 31%, P=0.02). Adenoma shrank in the 3 patients whose pituitary imaging was repeated during CAB.


CONCLUSIONS
These results envisage that CAB may represent a worthy therapeutic tool in acromegalic patients, inducing a degree of IGF-I and GH suppression comparable to SAs, administered by the oral route and much less expensive.
Cozzi
R
R
Division of Endocrinology, Ospedale Niguarda, Milano, Italy.
Attanasio
R
R
Barausse
M
M
Dallabonzana
D
D
Orlandi
P
P
Da Re
N
N
Branca
V
V
Oppizzi
G
G
Gelli
D
D
D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology; D000236:Adenoma / Q000150:complications / Q000473:pathology; D000328:Adult; D000368:Aged; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology; D011388:Prolactin / Q000097:blood
D018491:Dopamine Agonists; D004873:Ergolines; D007334:Insulin-Like Growth Factor I; D011388:Prolactin; D013006:Growth Hormone; D000077465:Cabergoline