Verhelst Johan A, Abrams Pascale J, Abs Roger
Department of Endocrinology, ZNA Middelheim, Lindendreef 1, Antwerp 2020, Belgium.
Pituitary. 2008;11(1):103-7. doi: 10.1007/s11102-007-0041-y.
Dopamine agonists are effective in some patients with acromegaly and in this condition treatment is considered to be chronic. We describe two acromegalic patients who responded adequately to the long-acting dopamine agonist cabergoline, but surprisingly maintained normal GH and IGF-I levels once therapy was discontinued after 42 and 76 months because of possibly related side effects. A 32-year-old woman with mild acromegaly (IGF-I: 423 microg/l, GH after OGTT: 2.5 microg/l, adenoma 4 mm) was treated with cabergoline as primary therapy and reached safe GH levels (2 microg/l or less) and normal IGF-I levels with 3.5 mg cabergoline weekly. After 42 months of therapy the patient experienced a progressive decrease of libido, which she attributed to the intake of cabergoline. After stopping medication, serum levels of GH and IGF-I remained normal during the following 2.5 years. A 53-year-old man with moderate acromegaly (serum IGF-I: 547 microg/l, GH after OGTT: 5.9 microg/l, adenoma 7 mm) preferred cabergoline as primary therapy. Serum GH levels below 2 microg/l and normal levels of IGF-I were obtained with 3.5 mg cabergoline weekly. When the patient experienced severe stomach pains after 76 months of treatment, cabergoline was held responsible and discontinued. Serum GH and IGF-I did not increase again and stayed at the same level during a follow-up of 5.5 years. These two cases demonstrate that acromegalic patients with a good response to cabergoline may occasionally remain in remission after stopping therapy. This phenomenon has previously only been described in patients with a prolactinoma.
多巴胺激动剂对一些肢端肥大症患者有效，在这种情况下，治疗被认为是长期的。我们描述了两名肢端肥大症患者，他们对长效多巴胺激动剂卡麦角林反应良好，但令人惊讶的是，由于可能相关的副作用，在治疗42个月和76个月后停药，他们的生长激素（GH）和胰岛素样生长因子-I（IGF-I）水平仍维持正常。一名32岁轻度肢端肥大症女性（IGF-I：423μg/L，口服葡萄糖耐量试验后GH：2.5μg/L，腺瘤4mm），以卡麦角林作为初始治疗，每周使用3.5mg卡麦角林达到了安全的GH水平（2μg/L或更低）和正常的IGF-I水平。治疗42个月后，患者出现性欲逐渐减退，她将其归因于卡麦角林的摄入。停药后，在接下来的2.5年中，血清GH和IGF-I水平仍保持正常。一名53岁中度肢端肥大症男性（血清IGF-I：547μg/L，口服葡萄糖耐量试验后GH：5.9μg/L，腺瘤7mm），选择卡麦角林作为初始治疗。每周使用3.5mg卡麦角林使血清GH水平低于2μg/L且IGF-I水平正常。治疗76个月后，患者出现严重胃痛，认为与卡麦角林有关并停药。血清GH和IGF-I没有再次升高，在5.5年的随访中保持在同一水平。这两个病例表明，对卡麦角林反应良好的肢端肥大症患者在停药后偶尔可能会保持缓解状态。这种现象以前仅在泌乳素瘤患者中被描述过。
