Withdrawal of Long-Term Cabergoline Therapy for Tumoral and Nontumoral Hyperprolactinemia

Colao, Annamaria; Sarno, Antonella Di; Cappabianca, Paolo; Somma, Carolina Di; Pivonello, Rosario; Lombardi, Gaetano

doi:10.1056/nejmoa022657

Cited by 303 publications

(173 citation statements)

References 42 publications

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“…The results obtained by our group and those discussed here seem to suggest that long-lasting dopaminergic agonists can be useful in the management of ACTH-secreting adenomas, in addition to other hormone-secreting adenomas and non-functioning pituitary tumors already known to be sensitive to such drugs [26, 27, 28, 29, 30]. …”

Section: Discussionmentioning

confidence: 67%

Nelson’s Syndrome: Complete Remission with Cabergoline but Not with Bromocriptine or Cyproheptadine Treatment

Casulari¹,

Naves²,

Mello

et al. 2004

Horm Res Paediatr

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A woman affected by Cushing’s disease underwent bilateral adrenalectomy followed by radiotherapy of the hypothalamic-pituitary area when she was 18 years old. Thereafter, she used hydrocortisone acetate replacement therapy (35.5 mg divided into two daily doses). At the age of 26 years, the patient exhibited the clinical signs of the Nelson’s syndrome, i.e. skin and gingival hyperpigmentation accompanied by amenorrhea, and elevated ACTH plasma levels (2,850 pg/ml, normal range 15–80 pg/ml). The magnetic resonance imaging (MRI) analysis of the sellar region evidenced a pituitary macroadenoma, measuring 14 × 13 mm. The patient was initially treated with cyproheptadine hydrochloride (12 mg/day) for 18 months. There was a partial improvement of the symptoms, with a reduction of the ACTH plasma levels to 112 pg/ml, but without any modification of the tumor mass. Due to sleepiness and weight gain, the cyproheptadine treatment was interrupted and substituted by a cabergoline (0.5 mg twice a week) therapy. Soon after cabergoline was applied an improvement of the clinical symptoms and signs was observed such as a regression of the tumor mass and the normalization of the ACTH plasma titers (38 pg/ml). Later, cabergoline was substituted by bromocriptine (7.5 mg/day) and the plasma levels of ACTH increased again (247 pg/ml), and headache and cutaneous hyperpigmentation were recorded. When cabergoline was reintroduced there was a clinical improvement and normalization of ACTH plasma levels (64 pg/ml). The MRI analysis of the sella region demonstrated a complete remission of the pituitary adenoma. The results obtained show for the first time that a long-term treatment with cabergoline also brings about a complete remission of Nelson’s syndrome in the presence of a pituitary macroadenoma.

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Section: Discussionmentioning

confidence: 67%

Nelson’s Syndrome: Complete Remission with Cabergoline but Not with Bromocriptine or Cyproheptadine Treatment

Casulari¹,

Naves²,

Mello

et al. 2004

Horm Res Paediatr

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“…Therefore, being able to discontinue SA in some patients with acromegaly, analogous to the situation in patients with prolactinomas treated with DA (14,15), is an attractive theoretical possibility. Based on the observations mentioned above, we hypothesized that in a subset of patients with acromegaly who respond extremely well to SA, as reflected by an excellent biochemical control with relatively low doses, such agents may cause irreversible functional changes in GH release and might therefore be stopped after several years of treatment.…”

Section: Introductionmentioning

confidence: 99%

Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying?

Ramírez

Vargas

González

et al. 2012

European Journal of Endocrinology

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Background: Somatostatin analogs (SA) have been used for over 25 years in the treatment of acromegaly. A major disadvantage is the need to continue therapy indefinitely. Objective: To evaluate the feasibility of discontinuing therapy in well-controlled patients with acromegaly treated chronically with SA. Design and methods: Of the 205 subjects on octreotide LAR, we selected those who met the following criteria: two or more years of treatment, a stable dose and injection interval of 20 mg every 8 weeks or longer for the previous year, no history of radiation, no cabergoline for the previous 6 months, a GH !1.5 ng/ml, and an IGF1 !1.2!upper limit of normal (ULN). Octreotide LAR was stopped and both GH and IGF1 were measured monthly for 4 months; a glucose-suppressed GH value and magnetic resonance imaging were obtained at the 4th month, thereafter, basal GH and IGF1 were measured q. 3 months, for 12-18 months. Patients were removed from the study if GH or IGF1 rose to 1.5 ng/ml or 1.2!ULN respectively. Results: Twelve patients (ten women, mean age 48G13 years) were studied. Seven patients (58.3%) relapsed biochemically within 1 year of having stopped the SA; two patients relapsed by GH and IGF1 criteria, the remaining five patients kept GH levels within target. Five patients (41.7%) remain in remission after 12 months of follow-up. Non-recurring patients were on longer injection intervals but no other characteristic was associated with a successful withdrawal. Conclusion: Withdrawal of SA is possible in a small but distinct subset of patients, particularly in those who are very well controlled on relatively low doses administered at long intervals.

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“…It is also important to note that studies have shown that pregnancy induces remission of hyperprolactinemia in two-thirds of women after discontinuation of DA (76-100% with non-tumoral hyperprolactinemia, 66-70% with microprolactinomas, 64-70% with macroprolactinomas). Although the exact mechanism is still unclear, it was hypothesized that autoinfarction of the tumour might be the reason for remission [88][89].…”

Section: Management Of Prolactinomas In Pregnancymentioning

confidence: 99%

Untitled

2015

Endocr oncol metab

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Objectives: Hyperprolactinemia is a common endocrine problem seen in everyday practice. Therefore, the Croatian society for endocrine oncology decided to write Croatian guidelines for the management of hyperprolactinemia that implements current scientific evidence with acknowledgement of economic and cultural specificities in Croatia. Methods: These guidelines were written by a Working group in the Croatian society for endocrine oncology, which included experts from different medical specialities that manage hyperprolactinemia, and were based on relevant scientific data. Results: These guidelines provide a comprehensive review of prolactin pathophysiology, the aetiology of hyperprolactinemia, as well as recommendations for the diagnostic and therapeutic approach to patients with hyperprolactinemia. Conclusion: These practical guidelines are in agreement with current scientific knowledge and will ensure better management of hyperprolactinemia in Croatia.

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Withdrawal of Long-Term Cabergoline Therapy for Tumoral and Nontumoral Hyperprolactinemia

Cited by 303 publications

References 42 publications

Nelson’s Syndrome: Complete Remission with Cabergoline but Not with Bromocriptine or Cyproheptadine Treatment

Nelson’s Syndrome: Complete Remission with Cabergoline but Not with Bromocriptine or Cyproheptadine Treatment

Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying?

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