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Cabergoline treatment for surgery-naïve non-functioning pituitary macroadenomas

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Abstract

Purpose

The treatment strategy of non-functioning pituitary adenomas (NFPAs) includes surgery, radiotherapy, medical therapy, or observation without intervention. Cabergoline, a dopaminergic agonist, was suggested for the treatment of NFPA remnants after trans-sphenoidal surgery. This study investigates the efficacy of cabergoline in surgery-naive patients with NFPA.

Methods

Retrospective cohort study including surgery-naive patients with NFPA ≥ 10 mm, treated with cabergoline at a dose of ≥ 1 mg/week for at least 24 months. Patients with chiasmal damage were excluded. Data collected included symptoms, in particular visual disturbances, hormonal levels, tumor characteristics and size evaluated by MRI. Tumor growth was defined as an increase in maximal diameter of ≥  2 mm, and shrinkage as reduction of ≥ 2 mm.

Results

Our cohort included 25 patients treated with cabergoline as primary therapy. Mean age was 63.3 ± 17.3 years, 56% (14/25) were males. Mean tumor size at diagnosis was 18.6 ± 6.3 mm (median 17 mm, range 10–36), and the average follow-up period with cabergoline was 4.6 ± 3.4 years. Out of the 25 tumors, five tumors (20%) decreased in size (mean decrease of 5.0 ± 3.0 mm), 12 tumors (48%) remained stable, and eight (32%) increased in size (mean growth of 5.0 ± 3.3 mm) with cabergoline treatment. During the first two years of cabergoline treatment, the median tumor size exhibited a reduction of 0.5 mm. Patients with an increase in tumor size had larger adenomas at diagnosis and a longer follow-up. Two patients (8%) underwent surgery due to tumor enlargement.

Conclusion

Primary treatment with cabergoline is a reasonable approach for selected patients with NFPAs without visual threat.

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, Beilinson Campus, Petah Tikva, 49100, Israel

    Irit Ayalon-Dangur, Dania Hirsch, Eyal Robenshtok, Gloria Tsvetov, Alexander Gorshtein, Hiba Masri, Ilana Shraga-Slutzky, Amit Akirov & Ilan Shimon

  2. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Irit Ayalon-Dangur, Adi Turjeman, Dania Hirsch, Eyal Robenshtok, Gloria Tsvetov, Alexander Gorshtein, Hiba Masri, Ilana Shraga-Slutzky, Amit Akirov & Ilan Shimon

  3. Research Authority, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel

    Adi Turjeman

  4. Maccabi Health Care Services, Tel Aviv, Israel

    Yossi Manisterski

Authors
  1. Irit Ayalon-Dangur
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  2. Adi Turjeman
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  10. Amit Akirov
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  11. Ilan Shimon
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Contributions

Study Conception and design: S.I, A,D.I.Acquisition of data: All authors.Analysis and interpretation of data: S.I, A,D.I, T.A.Drafting of the work: S.I, A,D.I.Critical Revision of the manuscript: All authors.Study supervision: S.I.Final approval of the manuscript: All authors.

Corresponding author

Correspondence to Ilan Shimon.

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Competing interests

The authors have nothing to declare.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Rabin Medical Center.

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Ayalon-Dangur, I., Turjeman, A., Hirsch, D. et al. Cabergoline treatment for surgery-naïve non-functioning pituitary macroadenomas. Pituitary 27, 52–60 (2024). https://doi.org/10.1007/s11102-023-01365-w

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