Cabergoline monotherapy in the long-term treatment of Cushing's disease.
BACKGROUND
Cabergoline is a long-acting dopamine receptor agonist used to treat prolactinomas. Identification of D(2) receptors in corticotroph tumors led to clinical trials of cabergoline therapy in limited cases of Nelson's syndrome, ectopic ACTH-secreting tumors, and recently Cushing's disease (CD).


OBJECTIVE
To evaluate the long-term efficacy of cabergoline monotherapy in patients with CD.


METHODS
Retrospective analysis of non-randomized clinical therapy with cabergoline in 30 patients with CD treated in academic centers of Buenos Aires and Montreal. Cabergoline was initiated at 0.5-1.0 mg/week and adjusted up to a maximal dose of 6 mg/week based on urinary free cortisol (UFC) levels. Complete response to cabergoline was defined as a sustained normalization of UFC with at least two normal values measured at 1-3 months interval; partial response was defined as a decrease of UFC to <125% of the upper limit of normal, and treatment failure as UFC ≥ 125% of it.


RESULTS
Within 3-6 months, complete response was achieved in 11 patients (36.6%) and partial response in 4 patients (13.3%). After long-term therapy, nine patients (30%) remain with a complete response after a mean of 37 months (range from 12 to 60 months) with a mean dose of 2.1 mg/week of cabergoline. Two patients escaped after 2 and 5 years of complete response, but one patient transiently renormalized UFC after an increase in cabergoline dosage. No long-term response was maintained in four initial partial responders.


CONCLUSIONS
Cabergoline monotherapy can provide an effective long-term medical therapy for selected patients with CD, but requires close follow-up for dose adjustments.
Godbout
Ariane
A
Endocrinology Division, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Hôtel-Dieu du CHUM, 3840 Rue Saint-Urbain, Montréal, Québec, Canada.
Manavela
Marcos
M
Danilowicz
Karina
K
Beauregard
Hugues
H
Bruno
Oscar Domingo
OD
Lacroix
André
A
D000328:Adult; D000368:Aged; D000077465:Cabergoline; D015331:Cohort Studies; D004873:Ergolines / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy* / Q000652:urine; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D004873:Ergolines; D000077465:Cabergoline; D006854:Hydrocortisone