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

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

doi:10.1097/00006254-200405000-00019

Cited by 57 publications

(107 citation statements)

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“…The present study reconfirms previous studies and shows that long-term (in this study, a mean follow-up of 7.5 years) tumor stabilization and shrinkage (in this study, a mean shrinkage of 30%) can be attained using cabergoline or quinagolide therapy. In four patients, dramatic (58-100%) tumor reduction, as can be seen in patients with macroprolactinomas (40)(41)(42)(43) and some patients with Nelson's syndrome (44)(45)(46), could be observed. However, as pathology was lacking in two of these patients, it cannot be excluded that these patients had poorly functioning prolactinomas.…”

Section: Discussionmentioning

confidence: 77%

Dopamine agonist therapy of clinically non-functioning pituitary macroadenomas. Is there a role for 123I-epidepride dopamine D2 receptor imaging?

Herder¹,

Reijs²,

Feelders³

et al. 2006

eur j endocrinol

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Objective: Clinically non-functioning pituitary adenomas (NFPAs) can express functional dopamine D2 receptors. Therapy with dopamine (DA) agonists may result in a NFPA size reduction. However, DA agonist-sensitive and -resistant NFPAs are clinically indistinguishable. We have studied the correlation between in vivo imaging of D2 receptors using 123 I-epidepride and the radiological response of NFPA to DA in 18 patients. Methods: Patients were treated with either cabergoline (1-2 mg/week) or quinagolide (150-300 mg/day) for a mean period of 89.7 months (range, 34-187 months). Results: Pituitary uptake of 123 I-epidepride varied from slight uptake classified as grade 0 to very high classified as grade 3. Grade 0 uptake was found in four patients; grade 1 in three; grade 2 in ten, and grade 3 in one. NFPA stabilization or shrinkage with DA agonist therapy showed no significant difference between grade 0, 1, and 2 tumors (mean tumor stabilization or shrinkage: 31, 30, and 36% respectively). However, when we considered a decrease in tumor size ranging from 0 to 20% as tumor stabilization and O20% decrease in tumor size as true shrinkage, one out of four NFPAs with grade 1 uptake, two out of three with grade 1 uptake, and eight out of ten with grade 2 uptake showed tumor shrinkage. Conclusion: In conclusion, there is limited clinical usefulness of dopamine D2 receptor imaging for predicting the clinical efficacy of DA agonist in selected patients with NFPAs. DA agonist therapy in NFPAs can result in tumor stabilization and shrinkage.European Journal of Endocrinology 155 717-723

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Section: Discussionmentioning

confidence: 77%

Dopamine agonist therapy of clinically non-functioning pituitary macroadenomas. Is there a role for 123I-epidepride dopamine D2 receptor imaging?

Herder¹,

Reijs²,

Feelders³

et al. 2006

eur j endocrinol

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“…Many studies also demonstrated that both primary and secondary prolonged treatments with SSTa are able to induce an enduring GH/IGF-I reduction and a pituitary tumor volume decrease in the majority of patients with acromegaly (8)(9)(10). However, to date, it is unknown whether SSTa may also provoke a longlasting disease remission in GH-secreting adenomas after drug discontinuation, similarly to the definitive cure of prolactinomas frequently induced by dopamine agonists (11,12).…”

Section: Introductionmentioning

confidence: 99%

Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal

Ronchi

Rizzo

Lania

et al. 2008

European Journal of Endocrinology

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Objective: It is still unknown whether prolonged treatment with somatostatin analogs (SSTa) may cause a long-lasting disease remission in GH-secreting adenomas after drug discontinuation. The aim of the present study was to investigate the evolution of GH/IGF-I secretion and tumor mass after SSTa withdrawal in patients affected by acromegaly. Patients and Design: A total of 27 patients with acromegaly (12 de novo and 15 previously operated) were treated with SSTa for a median period of 48 months and considered optimally controlled in hormonal and neuroradiological terms. None of them were previously irradiated. Methods: Basal GH, post-glucose GH nadir, IGF-I, clinical signs/symptoms, and metabolic parameters were evaluated after 12-16 weeks from drug withdrawal. Only patients who met the current criteria for disease remission remained in drug suspension being periodically re-evaluated for biochemical/-clinical data and neuroradiological imaging. Results: After 12-16 weeks withdrawal, 15 of the 27 patients had disease relapse and restarted SSTa, while 12 were considered 'in disease remission' (44% of total). Glucose metabolism improved in both euglycemic and diabetic patients after short-term SSTa discontinuation. Only one of the ten patients who reached 24 weeks withdrawal showed biochemical disease recurrence. On the whole, five of the patients still in remission after 6 months have already prolonged the follow-up over 12 months (median: 24 months), without clinical and biochemical/neuroradiological evidence of disease recurrence. Conclusions: These preliminary data indicate a successful withdrawal of SSTa at least in a subset of wellresponsive patients with acromegaly and challenge the previously held concept that medical therapy is always a lifelong requirement.

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“…Recent published data indicate that many patients may enter a long-term remission following treatment with cabergoline. 57 Resolution of the adenoma on MRI is predictive of a long-term remission. Normal PRL levels after bromocriptine withdrawal persist in only 20% of patients.…”

Section: B U S I N E S S B R I E F I N G : E U R O P E a N E N D O C mentioning

confidence: 99%

Hyperprolactinaemia – Differential Diagnosis, Investigation and Management

Inder¹

2006

European Endocrinology

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

Cited by 57 publications

References 0 publications

Dopamine agonist therapy of clinically non-functioning pituitary macroadenomas. Is there a role for 123I-epidepride dopamine D2 receptor imaging?

Dopamine agonist therapy of clinically non-functioning pituitary macroadenomas. Is there a role for 123I-epidepride dopamine D2 receptor imaging?

Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal

Hyperprolactinaemia – Differential Diagnosis, Investigation and Management

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