Ferrari C I, Abs R, Bevan J S, Brabant G, Ciccarelli E, Motta T, Mucci M, Muratori M, Musatti L, Verbessem G, Scanlon M F
Department of Medicine, S. Pio X Hospital, Milan, Italy.
Clin Endocrinol (Oxf). 1997 Apr;46(4):409-13. doi: 10.1046/j.1365-2265.1997.1300952.x.
Cabergoline is now established as an effective and well-tolerated treatment for prolactinoma. However, there are relatively few published data on the treatment of macro-, as opposed to micro-, prolactinoma. We have therefore reviewed the efficiency and safety of cabergoline in the treatment of patients with prolactin-secreting macroadenomas treated on a compassionate basis.
Eighty-five patients with prolactin-secreting macroadenomas were treated with cabergoline 0.25 to 10.5 mg per week (median 1 mg) given to one to seven doses. Treatment durations ranged between 3 months and 8 years. Sixty-five patients (32 intolerant, 16 resistant) had been treated previously with other dopamine agonists. Pretreatment prolactin levels ranged between 80 and 8300 micrograms/I and tumour maximum diameters were between 11 and 42 mm.
Serum prolactin, visual fields if initially abnormal, occurrence of menses or return of libido and potency, blood chemistry and adverse events were assessed at 1 month and then at 3-month intervals during treatment. Pituitary computed tomography or magnetic resonance imaging was usually repeated at 3 months and 1 year, then yearly, in most patients (n = 62).
Normalization of prolactin levels was achieved in 52 patients (61.2%) and a prolactin decrease of at least 75% of pretreatment values occurred in 24 others (28.2%). Of the 20 de novo patients, 17 had prolactin normalized and the remainder had at least 75% reduction. Disappearance of tumour image was found in eight of 62 evaluable patients (12.9%) and reduction of the largest diameter by at least 25% in another 33 (53.2%), with an overall success rate of 66.1%; among the 17 evaluable de novo patients the success rate was 82.3%. Fifteen of 21 patients who failed to show tumour shrinkage had previously demonstrated resistance/intolerance to other prolactin-lowering treatments. Of the 12 patients with visual field defects at baseline, six normalized and two showed an improvement. Menses resumed during cabergoline treatment in 79.5% of premenopausal women. Restoration of potency was reported by seven of eight evaluable men. Adverse events were recorded in 24.7% of cases, four of whom (4.7%) discontinued treatment.
Although the present data were not obtained in a formal study we conclude that cabergoline is an effective and well-tolerated treatment for macroprolactinoma patients.
卡麦角林现已被确立为治疗催乳素瘤的一种有效且耐受性良好的药物。然而，与微催乳素瘤相比，关于大催乳素瘤治疗的已发表数据相对较少。因此，我们回顾了卡麦角林在同情性治疗分泌催乳素大腺瘤患者中的有效性和安全性。
85例分泌催乳素大腺瘤患者接受卡麦角林治疗，每周剂量为0.25至10.5毫克（中位数为1毫克），分1至7次给药。治疗持续时间为3个月至8年。65例患者（32例不耐受，16例耐药）此前曾接受过其他多巴胺激动剂治疗。治疗前催乳素水平在80至8300微克/升之间，肿瘤最大直径在11至42毫米之间。
在治疗第1个月时评估血清催乳素水平、初始视野异常者的视野情况、月经恢复情况或性欲及性功能恢复情况、血液生化指标和不良事件，此后在治疗期间每3个月评估一次。大多数患者（n = 62）通常在3个月和1年时重复进行垂体计算机断层扫描或磁共振成像检查，之后每年检查一次。
52例患者（61.2%）催乳素水平恢复正常，另外24例患者（28.2%）催乳素水平至少降低至治疗前值的75%。在20例初治患者中，17例催乳素水平恢复正常，其余患者至少降低75%。在62例可评估患者中，8例（12.9%）肿瘤影像消失，另外33例（53.2%）最大直径至少缩小25%，总体成功率为66.1%；在17例可评估的初治患者中，成功率为82.3%。21例未出现肿瘤缩小的患者中有15例此前对其他降低催乳素的治疗表现出耐药/不耐受。基线时有视野缺损的12例患者中，6例恢复正常，2例有所改善。79.5%的绝经前女性在卡麦角林治疗期间月经恢复。8例可评估男性中有7例报告性功能恢复。24.7%的病例记录有不良事件，其中4例（4.7%）停止治疗。
尽管目前的数据并非来自正式研究，但我们得出结论，卡麦角林是治疗大催乳素瘤患者的一种有效且耐受性良好的药物。
