Cannavò S, Curtò L, Squadrito S, Almoto B, Vieni A, Trimarchi F
Cattedra di Endocrinologia, Università di Messina, Italy.
J Endocrinol Invest. 1999 May;22(5):354-9. doi: 10.1007/BF03343573.
Cabergoline (CAB) treatment is an effective, safe and well tolerated approach for hyperprolactinemia. We investigated the efficacy of 24-month treatment with CAB in 37 patients with previously untreated PRL-secreting pituitary adenoma and evaluated the hormonal and neuroradiological changes after the discontinuation of long-term therapy. Eleven patients with macroprolactinoma (1M/10F) and 26 with microprolactinoma (4M/22F) started treatment taking 0.25 mg CAB twice a week for 4 weeks. The dose was increased stepwise in 0.5 mg increments until reaching lowest maximally effective and tolerated dose. CAB was withdrawn before the end of the study in 6 women who became pregnant and in one patient who showed a slight increase of the macroadenoma at MRI. During treatment, PRL levels decreased significantly in macro (11.1+/-1.1 vs 407.8+/-98.3 microg/l, p<0.001) and microprolactinomas (11.1+/-1.6 vs 193.8+/-23.4 microg/l, p<0.05) and normalized in all macro and in 23/26 microprolactinomas. In 3 cases PRL levels decreased but did not normalize because the appearance of side effects, such as nausea or hypotension, prevented the increase of the dose of CAB. The effective dose of drug correlated significantly with basal serum PRL levels (p<0.05) and with the pituitary tumor size (p<0.05). A significant decrease of the mean adenoma size was evident for macro (6.9+/-1.8 vs 16.0+/-1.8 mm, p<0.001) and microprolactinomas (3.0+/-0.5 vs 6.5+/-0.4 mm, p<0.001) at MRI. The tumor disappeared in 4 macroadenomas and in 11 microadenomas after 12 months of treatment. CAB withdrawal was followed by serum PRL increase in 13 cases after 3 months, in 6 after 6 months, in 2 after 9 months, and in one patient at the 12th month. Five patients showed normoprolactinemia with negative MRI after one year. Regular menses were restored in 7/10 macroprolactinomas and in all oligo-amenorrhoic patients with microadenoma; serum testosterone levels normalized in 2/3 hypogonadic men. Five out of 6 women become pregnant and had uneventful pregnancies which resulted in deliveries of normal babies. In conclusion, this study confirms the effectiveness and safety of CAB for patients with PRL-secreting pituitary adenoma and suggests that it can be considered a first choice treatment.
卡麦角林（CAB）治疗是一种有效、安全且耐受性良好的高催乳素血症治疗方法。我们研究了37例既往未经治疗的泌乳素分泌型垂体腺瘤患者接受CAB治疗24个月的疗效，并评估了长期治疗停药后的激素和神经放射学变化。11例大泌乳素瘤患者（1例男性/10例女性）和26例微泌乳素瘤患者（4例男性/22例女性）开始治疗，每周服用0.25 mg CAB，共4周。剂量以0.5 mg的增量逐步增加，直至达到最低最大有效耐受剂量。在研究结束前，6例怀孕的女性和1例在MRI检查中显示大腺瘤略有增大的患者停用了CAB。治疗期间，大泌乳素瘤患者（11.1±1.1 vs 407.8±98.3 μg/l，p<0.001）和微泌乳素瘤患者（11.1±1.6 vs 193.8±23.4 μg/l，p<0.05）的PRL水平显著下降，所有大泌乳素瘤患者和23/26例微泌乳素瘤患者的PRL水平恢复正常。3例患者PRL水平下降但未恢复正常，因为出现了恶心或低血压等副作用，阻止了CAB剂量的增加。药物有效剂量与基础血清PRL水平（p<0.05）和垂体肿瘤大小（p<0.05）显著相关。MRI检查显示，大泌乳素瘤（6.9±1.8 vs 16.0±1.8 mm，p<0.001）和微泌乳素瘤（3.0±0.5 vs 6.5±0.4 mm，p<0.001）的平均腺瘤大小显著减小。治疗12个月后，4例大腺瘤和11例微腺瘤消失。停药后，13例患者在3个月后、6例在6个月后、2例在9个月后以及1例患者在12个月时血清PRL升高。5例患者在1年后泌乳素水平正常且MRI检查为阴性。7/10的大泌乳素瘤患者和所有微腺瘤导致的少经患者恢复了规律月经；2/3性腺功能减退男性的血清睾酮水平恢复正常。6例女性中有5例怀孕，孕期顺利，产下正常婴儿。总之，本研究证实了CAB对泌乳素分泌型垂体腺瘤患者的有效性和安全性，并表明它可被视为首选治疗方法。
