title: Individualized high-dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas.
abstract: BACKGROUND
  Cabergoline is effective for hyperprolactinemic hypogonadism. However, the rate of cabergoline-induced pregnancy in women with prolactinoma remains unknown. Also unknown is whether cabergoline can control tumor growth and thereby achieve successful pregnancy in patients with macroprolactinomas.
  
  
  METHODS
  Eighty-five women with macroprolactinomas (n = 29) or microprolactinomas (n = 56) received prospective, high-dose cabergoline therapy for infertility based on individual prolactin suppression and/or tumor shrinkage. The patients included 31 bromocriptine-resistant, 32 bromocriptine-intolerant, and 22 previously untreated women. Conception was withheld until three regular cycles returned in women with microadenoma and until tumors shrank below 1.0 cm in height in women with macroadenoma. Cabergoline was withdrawn at the fourth gestational week.
  
  
  RESULTS
  Cabergoline normalized hyperprolactinemia and recovered the ovulatory cycle in all patients. All adenomas contracted, and 11 macroadenomas and 29 microadenomas disappeared. Eighty patients (94%) conceived 95 pregnancies, two of which were cabergoline-free second pregnancies. The dose of cabergoline at the first pregnancy was 0.25-9 mg/wk overall and 2-9 mg/wk in the resistant patients. Of the 93 pregnancies achieved on cabergoline, 86 resulted in 83 single live births, one stillbirth, and two abortions; the remaining seven were ongoing. All babies were born healthy, without any malformations. No mothers experienced impaired vision or headache suggestive of abnormal tumor reexpansion throughout pregnancy.
  
  
  CONCLUSIONS
  Cabergoline achieved a high pregnancy rate with uneventful outcomes in infertile women with prolactinoma, independent of tumor size and bromocriptine resistance or intolerance. Cabergoline monotherapy could substitute for the conventional combination therapy of pregestational surgery or irradiation plus bromocriptine in macroprolactinomas.
authors.affiliation: Department of Medicine II, Institute of Clinical Endocrinology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Ono
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Miki
authors.forename: Kosaku
authors.initials: K
authors.lastname: Amano
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.forename: Toshiro
authors.initials: T
authors.lastname: Seki
authors.forename: Rena
authors.initials: R
authors.lastname: Makino
authors.forename: Kazue
authors.initials: K
authors.lastname: Takano
authors.forename: Shun-ichiro
authors.initials: S
authors.lastname: Izumi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
mesh_terms: D000328:Adult; D001724:Birth Weight; D001971:Bromocriptine / Q000009:adverse effects / Q000627:therapeutic use; D000077465:Cabergoline; D015331:Cohort Studies; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications* / Q000188:drug therapy*; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000150:complications* / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D011374:Progesterone / Q000097:blood; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000150:complications* / Q000473:pathology
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; D011374:Progesterone; D011388:Prolactin; D000077465:Cabergoline