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Short-term treatment with cabergoline can lead to tumor shrinkage in patients with nonfunctioning pituitary adenomas

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Abstract

This study was carried out to evaluate the effectiveness of cabergoline in the treatment of nonfunctioning pituitary adenomas (NFPA), in a short-term follow-up period. Nineteen patients (10 men and 9 women) followed at the University Hospital of Brasilia and harboring nonfunctioning pituitary macroadenomas were enrolled in the study. Eleven patients were previously submitted to transsphenoidal surgery, and in 8 patients no previous treatment had been instituted. Their response to the use of cabergoline (2 mg/week) by 6 months was evaluated. Significant tumor shrinkage (above 25 % from baseline tumor volume) was observed in 6 (31.6 %) of the 19 patients, and no adverse effects were observed during treatment. In 9 patients (47.4 %), a reduction in tumor volume of at least 10 % was noted, whereas tumor growth was observed in four patients (increase above 25 % was only observed in one patient). Cabergoline (2 mg/week) can lead to significant tumor shrinkage in NFPA in a considerable number of patients, and this effect can be observed early (6 months after starting medication). Thus, this therapeutic strategy may be a low cost and safe alternative for treatment of NFPA in patients with remnant or recurrent tumor after transsphenoidal surgery or in those not operated by contraindications or refusal to surgical procedure.

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References

  1. Jaffe CA (2006) Clinically non-functioning pituitary adenoma. Pituitary 9:317–321

    Article  PubMed  Google Scholar 

  2. Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A (2006) High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 91:4769–4775

    Article  PubMed  CAS  Google Scholar 

  3. Fernandez A, Karavitaki N, Wass JA (2010) Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 72:377–382

    Article  Google Scholar 

  4. Drange MR, Fram NR, Herman-Bonert V, Melmed S (2000) Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 85:168–174

    Article  PubMed  CAS  Google Scholar 

  5. Dekkers OM, Hammer S, de Keizer RJ, Roelfsema F, Schutte PJ, Smit JW, Romijn JA, Pereira AM (2007) The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol 156:217–224

    Article  PubMed  CAS  Google Scholar 

  6. Yamada S, Ohyama K, Taguchi M, Takeshita A, Morita K, Takano K, Sano T (2007) A study of the correlation between morphological findings and biological activities in clinically nonfunctioning pituitary adenomas. Neurosurgery 61, 580–584 (Discussion 584–585)

    Google Scholar 

  7. Cury ML, Fernandes JC, Machado HR, Elias LL, Moreira AC, Castro M (2009) Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging assessment, therapeutic management and outcome. Arq Bras Endocrinol Metabol 53:31–39

    Article  PubMed  Google Scholar 

  8. Bradley KM, Adams CB, Potter CP, Wheeler DW, Anslow PJ, Burke CW (1994) An audit of selected patients with non-functioning pituitary adenoma treated by transsphenoidal surgery without irradiation. Clin Endocrinol (Oxf) 41:655–659

    Article  CAS  Google Scholar 

  9. Greenman Y, Melmed S (1996) Diagnosis and management of nonfunctioning pituitary tumors. Annu Rev Med 47:95–106

    Article  PubMed  CAS  Google Scholar 

  10. Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA (1999) Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation—a follow-up study. Clin Endocrinol (Oxf) 51:281–284

    Article  CAS  Google Scholar 

  11. Greenman Y, Ouaknine G, Veshchev I, Reider G II, Segev Y, Stern N (2003) Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 58:763–769

    Article  CAS  Google Scholar 

  12. Losa M, Mortini P, Barzaghi R, Ribotto P, Terreni MR, Marzoli SB, Pieralli S, Giovanelli M (2008) Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence. J Neurosurg 108:525–532

    Article  PubMed  Google Scholar 

  13. Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA (1986) Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med 81:457–462

    Article  PubMed  CAS  Google Scholar 

  14. Gittoes NJ, Bates AS, Tse W, Bullivant B, Sheppard MC, Clayton RN, Stewart PM (1998) Radiotherapy for non-function pituitary tumours. Clin Endocrinol (Oxf) 48:331–337

    Article  CAS  Google Scholar 

  15. Bevan JS, Adams CB, Burke CW, Morton KE, Molyneux AJ, Moore RA, Esiri MM (1987) Factors in the outcome of transsphenoidal surgery for prolactinoma and non-functioning pituitary tumour, including pre-operative bromocriptine therapy. Clin Endocrinol (Oxf) 26:541–556

    Article  CAS  Google Scholar 

  16. van Schaardenburg D, Roelfsema F, van Seters AP, Vielvoye GJ (1989) Bromocriptine therapy for non-functioning pituitary adenoma. Clin Endocrinol (Oxf) 30:475–484

    Article  Google Scholar 

  17. Bevan JS, Webster J, Burke CW, Scanlon MF (1992) Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 13:220–240

    PubMed  CAS  Google Scholar 

  18. Greenman Y, Tordjman K, Osher E, Veshchev I, Shenkerman G, Reider G II, Segev Y, Ouaknine G, Stern N (2005) Postoperative treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists decreases tumour remnant growth. Clin Endocrinol (Oxf) 63:39–44

    Article  CAS  Google Scholar 

  19. Agrawal A, Cincu R, Goel A (2007) Current concepts and controversies in the management of non-functioning giant pituitary macroadenomas. Clin Neurol Neurosurg 109:645–650

    Article  PubMed  Google Scholar 

  20. Colao A, Di Somma C, Pivonello R, Faggiano A, Lombardi G, Savastano S (2008) Medical therapy for clinically non-functioning pituitary adenomas. Endocr Relat Cancer 15:905–915

    Article  PubMed  CAS  Google Scholar 

  21. Giusti M, Bocca L, Florio T, Foppiani L, Corsaro A, Auriati L, Spaziante R, Schettini G, Giordano G (2000) Cabergoline modulation of alpha-subunits and FSH secretion in a gonadotroph adenoma. J Endocrinol Invest 23:463–466

    PubMed  CAS  Google Scholar 

  22. Lohmann T, Trantakis C, Biesold M, Prothmann S, Guenzel S, Schober R, Paschke R (2001) Minor tumour shrinkage in nonfunctioning pituitary adenomas by long-term treatment with the dopamine agonist cabergoline. Pituitary 4:173–178

    Article  PubMed  CAS  Google Scholar 

  23. de Herder WW, Reijs AE, Feelders RA, van Aken MO, Krenning EP, Tanghe HL, van der Lely AJ, Kwekkeboom DJ (2006) Dopamine agonist therapy of clinically non-functioning pituitary macroadenomas. Is there a role for 123I-epidepride dopamine D2 receptor imaging? Eur J Endocrinol 155:717–723

    Article  PubMed  Google Scholar 

  24. Pivonello R, Matrone C, Filippella M, Cavallo LM, Di Somma C, Cappabianca P, Colao A, Annunziato L, Lombardi G (2004) Dopamine receptor expression and function in clinically nonfunctioning pituitary tumors: comparison with the effectiveness of cabergoline treatment. J Clin Endocrinol Metab 89:1674–1683

    Article  PubMed  CAS  Google Scholar 

  25. Renner U, Arzberger T, Pagotto U, Leimgruber S, Uhl E, Muller A, Lange M, Weindl A, Stalla GK (1998) Heterogeneous dopamine D2 receptor subtype messenger ribonucleic acid expression in clinically nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 83:1368–1375

    Article  PubMed  CAS  Google Scholar 

  26. de Herder WW, Reijs AE, Feelders RA, van Aken MO, Krenning EP, van der Lely AJ, Kwekkeboom DJ (2007) Diagnostic imaging of dopamine receptors in pituitary adenomas. Eur J Endocrinol 156(Suppl 1):S53–S56

    Article  PubMed  Google Scholar 

  27. Colao A, Ferone D, Lastoria S, Cerbone G, Di Sarno A, Di Somma C, Lucci R, Lombardi G (2000) Hormone levels and tumour size response to quinagolide and cabergoline in patients with prolactin-secreting and clinically non-functioning pituitary adenomas: predictive value of pituitary scintigraphy with 123I-methoxybenzamide. Clin Endocrinol (Oxf) 52:437–445

    Article  CAS  Google Scholar 

  28. Johnston DG, Hall K, McGregor A, Ross WM, Kendall-Taylor P, Hall R (1981) Bromocriptine therapy for “nonfunctioning” pituitary tumors. Am J Med 71:1059–1061

    Article  PubMed  CAS  Google Scholar 

  29. Wollesen F, Andersen T, Karle A (1982) Size reduction of extrasellar pituitary tumors during bromocriptine treatment. Ann Intern Med 96:281–286

    Article  PubMed  CAS  Google Scholar 

  30. Wass JA, Williams J, Charlesworth M, Kingsley DP, Halliday AM, Doniach I, Rees LH, McDonald WI, Besser GM (1982) Bromocriptine in management of large pituitary tumours. Br Med J (Clin Res Ed) 284:1908–1911

    Article  CAS  Google Scholar 

  31. Barrow DL, Tindall GT, Kovacs K, Thorner MO, Horvath E, Hoffman JC Jr (1984) Clinical and pathological effects of bromocriptine on prolactin-secreting and other pituitary tumors. J Neurosurg 60:1–7

    Article  PubMed  CAS  Google Scholar 

  32. Pullan PT, Carroll WM, Chakera TM, Khangure MS, Vaughan RJ (1985) Management of extra-sellar pituitary tumours with bromocriptine: comparison of prolactin secreting and non-functioning tumours using half-field visual evoked potentials and computerised tomography. Aust N Z J Med 15:203–208

    Article  PubMed  CAS  Google Scholar 

  33. Verde G, Oppizzi G, Chiodini PG, Dallabonzana D, Luccarelli G, Liuzzi A (1985) Effect of chronic bromocriptine administration on tumor size in patients with “nonsecreting” pituitary adenomas. J Endocrinol Invest 8:113–115

    PubMed  CAS  Google Scholar 

  34. Zarate A, Moran C, Kleriga E, Loyo M, Gonzalez-Angulo A, Aquilar-Parada E (1985) Bromocriptine therapy as pre-operative adjunct of non-functional pituitary macroadenomas. Acta Endocrinol (Copenh) 108:445–450

    CAS  Google Scholar 

  35. Vance ML, Ridgway EC, Thorner MO (1985) Follicle-stimulating hormone- and alpha-subunit-secreting pituitary tumor treated with bromocriptine. J Clin Endocrinol Metab 61:580–584

    Article  PubMed  CAS  Google Scholar 

  36. Colao A, Filippella M, Pivonello R, Di Somma C, Faggiano A, Lombardi G (2007) Combined therapy of somatostatin analogues and dopamine agonists in the treatment of pituitary tumours. Eur J Endocrinol 156(Suppl 1):S57–S63

    Article  PubMed  CAS  Google Scholar 

  37. Andersen M, Bjerre P, Schroder HD, Edal A, Hoilund-Carlsen PF, Pedersen PH, Hagen C (2001) In vivo secretory potential and the effect of combination therapy with octreotide and cabergoline in patients with clinically non-functioning pituitary adenomas. Clin Endocrinol (Oxf) 54:23–30

    Article  CAS  Google Scholar 

  38. Padova H, Rubinfeld H, Hadani M, Cohen ZR, Nass D, Taylor JE, Culler MD, Shimon I (2008) Effects of selective somatostatin analogs and cortistatin on cell viability in cultured human non-functioning pituitary adenomas. Mol Cell Endocrinol 286:214–218

    Article  PubMed  CAS  Google Scholar 

  39. Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007) Dopamine agonists and the risk of cardiac-valve regurgitation. N Engl J Med 356:29–38

    Article  PubMed  CAS  Google Scholar 

  40. Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356:39–46

    Article  PubMed  CAS  Google Scholar 

  41. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:273–288

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Sabin Laboratory of Clinical Analysis for providing technical assistance in hormonal tests.

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The authors declare that no conflict of interest exists.

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Correspondence to Monalisa F. Azevedo.

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Garcia, E.C., Naves, L.A., Silva, A.O. et al. Short-term treatment with cabergoline can lead to tumor shrinkage in patients with nonfunctioning pituitary adenomas. Pituitary 16, 189–194 (2013). https://doi.org/10.1007/s11102-012-0403-y

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