Colao A, Ferone D, Marzullo P, Di Sarno A, Cerbone G, Sarnacchiaro F, Cirillo S, Merola B, Lombardi G
Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy.
J Clin Endocrinol Metab. 1997 Feb;82(2):518-23. doi: 10.1210/jcem.82.2.3648.
Medical treatment of acromegaly with dopamine agonists possesses 2 main advantages: the oral administration and the low costs. In this study, we reported on the results of chronic treatments with quinagolide (CV 205-502), cabergoline (CAB) and long-acting depot preparation of bromocriptine (BRC-LAR) in 34 acromegalics. Patients were divided into three groups on the basis of different treatment: CV 205-502 given to 16 patients at the dose of 0.3-0.6 mg/day for 6 months; CAB given to 11 patients at the dose of 1.0-2.0 mg weekly for 6 months; and BRC-LAR injected into 7 patients at the dose of 100 mg/month for 6-12 months. Basal and oral glucose tolerance test-stimulated serum GH levels, basal and TRH-stimulated PRL levels, plasma insulin-like growth factor I (IGF-I) levels, computed tomography scan, and/or magnetic resonance imaging were assessed before and quarterly during treatments. The chronic administration of CV 205-502, CAB, and BRC-LAR caused a significant decrease of circulating GH, IGF-I, and PRL levels (P < 0.005). Normalization of circulating GH and IGF-I levels was obtained in 7 of 16 (43.8%) patients treated with CV 205-502. Serum GH response to oral glucose tolerance test (oGTT) significantly improved (P < 0.005), and PRL levels were significantly suppressed during treatments. No correlation was found between basal and TRH-stimulated PRL levels and GH suppression during different therapies. Immunohistochemical staining revealed 19 GH-positive and 10 GH + PRL-positive adenomas. A significant association was found between GH/PRL staining and responsiveness to chronic treatments (chi 2 = 7.985, P < 0.005). Three patients had significant adenoma shrinkage. Slight nausea and hypotension which spontaneously disappeared within therapy progression, were referred by 5/16 patients during CV 205-502 and 2/7 during BRC-LAR. The results of this study indicate that CAB and BRC-LAR cannot be considered as useful medical approaches for acromegalics, whereas CV 205-502 normalized circulating GH and IGF-I levels in 47.8% of patients.
口服给药和成本低廉。在本研究中，我们报告了34例肢端肥大症患者使用喹高利特（CV 205 - 502）、卡麦角林（CAB）和长效溴隐亭注射剂（BRC - LAR）进行长期治疗的结果。根据不同治疗方法将患者分为三组：16例患者给予CV 205 - 502，剂量为0.3 - 0.6毫克/天，持续6个月；11例患者给予CAB，剂量为每周1.0 - 2.0毫克，持续6个月；7例患者注射BRC - LAR，剂量为每月100毫克，持续6 - 12个月。在治疗前及治疗期间每季度评估基础及口服葡萄糖耐量试验刺激后的血清生长激素（GH）水平、基础及促甲状腺激素释放激素（TRH）刺激后的催乳素（PRL）水平、血浆胰岛素样生长因子I（IGF - I）水平、计算机断层扫描和/或磁共振成像。长期给予CV 205 - 502、CAB和BRC - LAR可使循环中的GH、IGF - I和PRL水平显著降低（P < 0.005）。16例接受CV 205 - 502治疗的患者中有7例（43.8%）循环中的GH和IGF - I水平恢复正常。口服葡萄糖耐量试验（oGTT）刺激后的血清GH反应显著改善（P < 0.005），治疗期间PRL水平被显著抑制。在不同治疗中，基础及TRH刺激后的PRL水平与GH抑制之间未发现相关性。免疫组织化学染色显示19例GH阳性和10例GH + PRL阳性腺瘤。GH/PRL染色与长期治疗反应之间存在显著关联（卡方 = 7.985，P < 0.005）。3例患者腺瘤明显缩小。5/16例接受CV 205 - 502治疗的患者和2/7例接受BRC - LAR治疗的患者出现轻微恶心和低血压，并在治疗过程中自行消失。本研究结果表明，CAB和BRC - LAR不能被视为治疗肢端肥大症的有效药物方法，而CV 205 - 502可使47.8%的患者循环中的GH和IGF - I水平恢复正常。
