Colao Annamaria, Vitale Giovanni, Cappabianca Paolo, Briganti Francesco, Ciccarelli Antonio, De Rosa Michele, Zarrilli Stefano, Lombardi Gaetano
Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, 80131 Naples, Italy.
J Clin Endocrinol Metab. 2004 Apr;89(4):1704-11. doi: 10.1210/jc.2003-030979.
The outcome of 24 months of cabergoline treatment on prolactin (PRL) normalization, tumor shrinkage, restoration of pituitary function, and semen alterations was prospectively investigated in 41 men with macro- (age 17-70 yr) and 10 with microprolactinoma (age 18-53 yr). Fifty-one age-matched men served as controls for semen analysis. At study entry, of the 41 patients with macroprolactinoma, 17 (41.4%) had visual field defects, 14 (34.1%) had headache, eight (19.5%) had galactorrhea, 22 (53.6%) had hypopituitarism apart from hypogonadism, and 30 (73.2%) had low testosterone levels; of the 10 patients with microprolactinoma, none had visual field defects, galactorrhea, or hypopituitarism apart from hypogonadism, two had headache (20%), and five had low testosterone levels (50%; P = 0.3). After 24 months of therapy, 1) PRL levels normalized in 31 patients with macro- (75.6%) and in eight with microprolactinoma (80%; P = 0.9), and galactorrhea disappeared in all patients; 2) maximal tumor diameter reduced by 73.7 +/- 22.6% in macro- and 72.8 +/- 28.3% in microprolactinomas (P = 0.91), and 15 macro- (30%) and seven microprolactinomas (46.7%; P = 0.37) disappeared; 3) visual field defects disappeared in 15 (75%) patients with macroprolactinoma, and headache disappeared in 15 (83%) patients with macro- and in one with microprolactinoma (50%); 4) GH secretion recovered in 62.5% and ACTH secretion in 60% of patients; 5) testosterone levels normalized in 25 patients with macro- (60.9%) and six with microprolactinoma (60%) after 6 months, and 20 patients required testosterone or gonadotropin replacement (in 14 or six patients, respectively); and 6) sperm volume and count normalized in all patients who normalized testosterone levels, whereas motility normalized in more than 80%. Cabergoline therapy was well tolerated; only 4.5% of patients had side effects at high doses. These data demonstrate that cabergoline treatment is as effective and safe in men as in women with prolactinoma and can be successfully used as primary therapy even in men bearing large macroprolactinomas.
对41例患有大泌乳素瘤（年龄17 - 70岁）和10例患有微泌乳素瘤（年龄18 - 53岁）的男性患者，前瞻性地研究了卡麦角林治疗24个月对泌乳素（PRL）正常化、肿瘤缩小、垂体功能恢复以及精液改变的效果。51例年龄匹配的男性作为精液分析的对照。在研究开始时，41例大泌乳素瘤患者中，17例（41.4%）有视野缺损，14例（34.1%）有头痛，8例（19.5%）有溢乳，22例（53.6%）除性腺功能减退外还有垂体功能减退，30例（73.2%）睾酮水平低；10例微泌乳素瘤患者中，除性腺功能减退外均无视野缺损、溢乳或垂体功能减退，2例（20%）有头痛，5例（50%）睾酮水平低（P = 0.3）。经过24个月的治疗，1）31例大泌乳素瘤患者（75.6%）和8例微泌乳素瘤患者（80%）的PRL水平恢复正常（P = 0.9），所有患者溢乳消失；2）大泌乳素瘤最大肿瘤直径缩小73.7±22.6%，微泌乳素瘤缩小72.8±28.3%（P = 0.91），15例大泌乳素瘤（30%）和7例微泌乳素瘤（46.7%）消失（P = 0.37）；3）15例（75%）大泌乳素瘤患者视野缺损消失，15例（83%）大泌乳素瘤患者和1例（50%）微泌乳素瘤患者头痛消失；4）62.5%的患者生长激素分泌恢复，60%的患者促肾上腺皮质激素分泌恢复；5）6个月后，25例大泌乳素瘤患者（60.9%）和6例微泌乳素瘤患者（60%）的睾酮水平恢复正常，20例患者需要睾酮或促性腺激素替代治疗（分别为14例或6例患者）；6）睾酮水平恢复正常的所有患者精液量和计数恢复正常，而活力恢复正常的患者超过80%。卡麦角林治疗耐受性良好；仅4.5%的患者在高剂量时有副作用。这些数据表明，卡麦角林治疗对男性泌乳素瘤患者与女性一样有效且安全，即使对患有大型大泌乳素瘤的男性也可成功用作初始治疗。
