De Rosa M, Colao A, Di Sarno A, Ferone D, Landi M L, Zarrilli S, Paesano L, Merola B, Lombardi G
Department of Endocrinology and Molecular and Clinical Oncology, Federico II University, Naples, Italy.
Eur J Endocrinol. 1998 Mar;138(3):286-93. doi: 10.1530/eje.0.1380286.
This study evaluated the effects of chronic treatment with cabergoline (CAB), a new, potent and long-lasting ergoline-derived dopamine agonist, on seminal fluid parameters and sexual and gonadal function in hyperprolactinemic males in comparison with the effect of bromocriptine (BRC) treatment. Seventeen males with macroprolactinoma were treated with CAB at a dose of 0.5-1.5 mg/week (n = 7), or BRC at a dose of 5-15 mg/day (n = 10) for 6 months. Baseline prolactin (PRL) was 925.7 +/- 522.6 microg/l in the CAB-treated group and 1059.4 +/- 297.6 microg/l in the BRC-treated group. All the patients suffered from libido impairment, ten from reduced sexual potency, and six had infertility. In five patients provocative bilateral galactorrhea was found. Seminal fluid analysis, functional seminal tests and penis rigidity and tumescence, measured by nocturnal penile tumescence (NPT) using Rigiscan equipment, were assessed before and after 1, 3 and 6 months of CAB or BRC treatment. Hormone profiles were assessed before and after 15, 30, 60, 90 and 180 days of both treatments. Before treatment, all patients had a low sperm count with oligoasthenospermia, reduced motility and rapid progression with an abnormal morphology and decreased viability, and a low number of erections. After 1 month, serum PRL levels were significantly reduced in both groups of patients (20.6 +/- 6.6 microg/l during CAB and 256.3 +/- 115.1 microg/l during BRC treatment) and were normalized after 6 months in all patients (CAB: 7.9 +/- 2.2 microg/l; BRC: 16.7 +/- 1.8 microg/l). After 6 months, a significant increase of number, total motility, rapid progression and normal morphology was recorded in patients treated with both CAB and BRC. An increase in the number of erections during the first 3 months of both treatments was noted by NPT. However, the improvements in seminal fluid parameters and sexual function were more evident and rapid in patients treated with CAB. The number of erections was normalized after 6 months of treatment in all patients submitted to CAB treatment, and in all patients but one treated by BRC. In addition, a significant increase of serum testosterone (from 3.7 +/- 0.3 to 5.3 +/- 0.2 microg/l) and dihydrotestosterone (from 0.4 +/- 0.1 to 1.1 +/- 0.1 nmol/l) was recorded. At the beginning of treatment, mild side-effects were recorded in two patients after CAB and mild-to-moderate side-effects in five patients after BRC administration. The treatment with CAB normalized PRL levels, improving gonadal and sexual function and fertility in males with prolactinoma, earlier than did BRC treatment, providing good tolerability and excellent patient compliance to medical treatment.
本研究评估了新型强效长效麦角林衍生多巴胺激动剂卡麦角林（CAB）长期治疗对高泌乳素血症男性精液参数、性功能和性腺功能的影响，并与溴隐亭（BRC）治疗效果进行比较。17例大泌乳素瘤男性患者，分别接受剂量为0.5 - 1.5mg/周的CAB治疗（n = 7）或剂量为5 - 15mg/天的BRC治疗（n = 10），为期6个月。CAB治疗组基线泌乳素（PRL）为925.7±522.6μg/l，BRC治疗组为1059.4±297.6μg/l。所有患者均有性欲减退，10例性功能减退，6例不育。5例患者有双侧诱发性溢乳。在CAB或BRC治疗1、3和6个月前后，评估精液分析、功能性精液检测以及使用Rigiscan设备通过夜间阴茎胀大（NPT）测量的阴茎硬度和肿胀情况。在两种治疗的15、30、60、90和180天后评估激素水平。治疗前，所有患者精子计数低，伴有少弱精子症，活力降低，快速进展型异常形态且活力下降，勃起次数少。1个月后，两组患者血清PRL水平均显著降低（CAB治疗期间为20.6±6.6μg/l，BRC治疗期间为256.3±115.1μg/l），6个月后所有患者PRL水平均恢复正常（CAB：7.9±2.2μg/l；BRC：16.7±1.8μg/l）。6个月后，接受CAB和BRC治疗的患者精子数量、总活力、快速进展型和正常形态均显著增加。NPT显示，两种治疗前3个月勃起次数均增加。然而，CAB治疗患者精液参数和性功能的改善更明显且迅速。接受CAB治疗的所有患者以及接受BRC治疗的除1例之外的所有患者，治疗6个月后勃起次数恢复正常。此外，血清睾酮（从3.7±0.3增至5.3±0.2μg/l）和双氢睾酮（从0.4±0.1增至1.1±0.1nmol/l）显著增加。治疗开始时，2例接受CAB治疗的患者出现轻度副作用，5例接受BRC治疗的患者出现轻至中度副作用。与BRC治疗相比，CAB治疗能更快使PRL水平恢复正常，改善泌乳素瘤男性的性腺和性功能以及生育能力，耐受性良好，患者对治疗的依从性极佳。
