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Clinical Use of Cabergoline as Primary and Adjunctive Treatment for Acromegaly

V Moyes, Department of Endocrinology, St. Bartholomew's Hospital, London, United Kingdom
K Metcalfe, Dept of Endocrinology, Southend Hospital, Southend-on-Sea, United Kingdom
W Drake, Dept of Endocrinology, St Bartholomew's Hospital, London, United Kingdom

Correspondence: Veronica Moyes, Email: v.moyes{at}qmul.ac.uk

Abstract

Background:

Cabergoline is a dopamine agonist that may be used as primary or adjunctive therapy for acromegaly. Although one study suggested biochemical control may be achieved in a substantial proportion of patients1 it is still commonly perceived to be a relatively ineffective treatment.

Design and Method:

A prospective audit was performed of 15 consecutive acromegalic patients (8 male, 7 female, median age 55, range 31-92 at presentation) treated with cabergoline to determine the effective dose and tolerability. All had normal anterior pituitary function; two patients had hyperprolactinaemia. MRI revealed 9 adenomata, 2 partially empty sellae and 4 structurally normal pituitary glands. 9 patients had undergone trans-sphenoidal surgery 1-12 months, and 1 patient had received pituitary radiotherapy 18 years, prior to commencement of cabergoline. All patients had biochemical GH excess; median serum IGF-I 471ng/ml, range 239-746ng/ml. The calculated mean of a series of GH measurements ranged from 2.7-45.8miu/l, median 9.7miu/L.

Results:

On a median weekly dose of cabergoline of 1.75mg (range 0.5-7mg) normalisation of both IGF-I and GH occurred in four out of 15 patients (27%). Five of 15 patients (33%) achieved a serum IGF-I within the reference range with notable reductions seen in a further five patients. Nine patients (60%) achieved a mean serum GH level of less than 5miu/L. Duration of treatment was 2 to 52 months and was well tolerated in 14 patients.

Conclusion:

Cabergoline can be an effective and well tolerated primary or adjunctive therapy for acromegaly and useful clinical responses are noted even with modest doses.