title: Effect of long-term cabergoline therapy on the immunological pattern and pituitary function of patients with idiopathic hyperprolactinaemia positive for antipituitary antibodies.
abstract: OBJECTIVE
  The occurrence of antipituitary antibodies (APA) in patients with idiopathic hyperprolactinaemia (IH) and the effects of dopamine agonists on these antibodies and long-term pituitary function outcome have been so far not evaluated. This longitudinal study was aimed at investigating, in patients with IH the occurrence of APA and the effect of cabergoline on the pituitary function and behaviour of APA.
  
  
  METHODS
  Sixty-six patients with IH were studied. APA (by indirect immunofluorescence) and pituitary function were investigated every year for 3 years.
  
  
  RESULTS
  Seventeen patients resulted APA positive (Group 1) and 49 APA negative (Group 2). Eight patients of Group 1 (Group 1a) and 24 of Group 2 (Group 2a) were asymptomatic and then not treated; instead, nine patients in Group 1 (Group 1b) and 25 in Group 2 (Group 2b), showing symptoms of hyperprolactinaemia, were treated with cabergoline for 2 years. Among the untreated patients, during the follow-up, those with APA positive (Group 1a) showed an increase of APA titres and PRL levels with partial pituitary impairment in some of them; instead those with APA negative (Group 2a) persisted negative with normal pituitary function despite persistent hyperprolactinaemia. Among the treated patients, those with APA positive (Group 1b) showed normalization of PRL levels, APA disappearance and recovery of pituitary function (when initially impaired) during cabergoline treatment, persisting also at last observation (off-therapy). Instead all patients of Group 2b persisted with APA negative during the follow-up with normalization of PRL levels and stable normal pituitary function during cabergoline therapy but showing a further increase of PRL at the last observation.
  
  
  CONCLUSIONS
  The presence of APA in some patients with IH suggests a possible occurrence of autoimmune hypophysitis at potential/subclinical stage; an early and prolonged cabergoline therapy could interrupt the progression to an overt clinical stage of the disease. However, the small amount of patients investigated suggests caution against generalization of our assumption and prompts to further controlled studies on a more numerous population to verify these conclusions.
authors.affiliation: Department of Clinical and Experimental Medicine and Surgery F. Magrassi, A. Lanzara, Second University of Naples, Italy. annamaria.debellis@unina2.it
authors.forename: A
authors.initials: A
authors.lastname: De Bellis
authors.forename: A
authors.initials: A
authors.lastname: Colao
authors.forename: A
authors.initials: A
authors.lastname: Savoia
authors.forename: C
authors.initials: C
authors.lastname: Coronella
authors.forename: D
authors.initials: D
authors.lastname: Pasquali
authors.forename: M
authors.initials: M
authors.lastname: Conte
authors.forename: R
authors.initials: R
authors.lastname: Pivonello
authors.forename: A
authors.initials: A
authors.lastname: Bellastella
authors.forename: A A
authors.initials: AA
authors.lastname: Sinisi
authors.forename: A
authors.initials: A
authors.lastname: Bizzarro
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: G
authors.initials: G
authors.lastname: Bellastella
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000139:chemically induced / Q000453:epidemiology; D000077465:Cabergoline; D015331:Cohort Studies; D018491:Dopamine Agonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D004873:Ergolines / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D006727:Hormone Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D008137:Longitudinal Studies; D008297:Male; D010900:Pituitary Diseases / Q000139:chemically induced / Q000453:epidemiology; D010901:Pituitary Function Tests; D010902:Pituitary Gland / Q000187:drug effects* / Q000276:immunology / Q000503:physiopathology; D016036:Seroepidemiologic Studies; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood; D013997:Time Factors
chemical_list: D001323:Autoantibodies; D018491:Dopamine Agonists; D004873:Ergolines; D006727:Hormone Antagonists; D013963:Thyroid Hormones; D013972:Thyrotropin; D000077465:Cabergoline