Cabergoline treatment rapidly improves gonadal function in hyperprolactinemic males: a comparison with bromocriptine

Abstract

This study evaluated the effects of chronic treatment with cabergoline (CAB), a new, potent and longlasting ergoline-derived dopamine agonist, on seminal¯uid parameters and sexual and gonadal function in hyperprolactinemic males in comparison with the effect of bromocriptine (BRC) treatment.Seventeen males with macroprolactinoma were treated with CAB at a dose of 0.5±1.5 mg/week (n 7), or BRC at a dose of 5±15 mg/day (n 10) for 6 months. Baseline prolactin (PRL) was 925.7 6 522.6 mg/l in the CAB-treated group and 1059.4 6 297.6 mg/l in the BRC-treated group. All the patients suffered from libido impairment, ten from reduced sexual potency, and six had infertility. In ®ve patients provocative bilateral galactorrhea was found.Seminal¯uid analysis, functional seminal tests and penis rigidity and tumescence, measured by nocturnal penile tumescence (NPT) using Rigiscan equipment, were assessed before and after 1, 3 and 6 months of CAB or BRC treatment. Hormone pro®les were assessed before and after 15, 30, 60, 90 and 180 days of both treatments.Before treatment, all patients had a low sperm count with oligoasthenospermia, reduced motility and rapid progression with an abnormal morphology and decreased viability, and a low number of erections. After 1 month, serum PRL levels were signi®cantly reduced in both groups of patients (20.6 6 6.6 mg/l during CAB and 256.3 6 115

Specificity of the neuroendocrine response to orgasm during sexual arousal in men

“…This position is supported by a wealth of data from both animal and human studies demonstrating a marked inhibitory effect of hyperprolactinemia on sexual drive, arousal and gonadal function (Doherty et al 1986, Walsh & Pullan 1997, Yazigi et al 1997, Rehmann et al 2000. Importantly, these effects are reversed upon pharmacological or surgical restoration of normal prolactin levels (De Rosa et al 1998, Verhelst et al 1999.…”

Cabergoline in the Treatment of Hyperprolactinemia: A Study in 455 Patients

“…Similarly, better results were obtained with cabergoline, compared with bromocriptine, in macroprolactinomas (5-7). Also, in males, cabergoline restored sexual function and fertility earlier than bromocriptine (8). Finally, a majority of patients intolerant or resistant to bromocriptine responded adequately to cabergoline (9 -11).…”

Aspectos clínicos e terapêuticos de prolactinomas em homens

“…Nos estudos analisados a incidência de redução de libido varia de 66,66% a 100% 7-9,11,12 e a de disfunção erétil de 35,71% a 100% 7,9,11,12 . Na nossa casuística foram relatadas em apenas 29,27% e 34,15%, respectivamente.…”

“…Outros autores relataram ginecomastia em 5,55% a 31% 8,9 e galactorréia em 4 a 30% 7,8,11,12 . Esta última é virtualmente patognomô-nica de prolactinoma quando ocorre em homens.…”

“…Atraso puberal e baixa estatura ocorreram em apenas 4,88% dos pacientes, enquanto há relatos de 6,66% a 9,09% 9 na literatura. No entanto, vale notar como é rara esta apresentação em outros estudos com grandes casuísticas de prolactinomas em adolescentes e crianças, como é o caso de Colao et al 15 A infertilidade ocorreu em apenas 2,44%, valor menor que o relatado em outros trabalhos -8,88% a 70% 7,9,11,12 . Ressaltamos que em apenas 1 a 5% dos homens com quadro de infertilidade, tem sido encontrada hiperprolactinemia 16,17 .…”