Abstract
Objective
Hyperprolactinemia is common in acromegaly and in these patients, insulin-like growth factor (IGF)-1 level may decrease with dopamine agonist. We report a series of patients with prolactinoma and a paradoxical increase of IGF-1 levels during cabergoline treatment.
Methods
Clinical characteristics and response to treatment of patients with prolactinomas, in whom normal or slightly elevated baseline IGF-1 levels increased with cabergoline.
Results
The cohort consisted of ten prolactinoma patients (nine males, mean age 48 ± 14 years). Mean adenoma size was 23.8 ± 16.2 mm, with cavernous sinus invasion in eight. In five patients baseline IGF-1 levels were normal and in four levels were 1.2–1.5-fold the upper limit of the normal (ULN). One patient had IGF-1 measured shortly after initiating cabergoline and it was 1.4 × ULN. During cabergoline treatment (dose range 0.5–2 mg/week) PRL normalization was achieved in all and tumor shrinkage occurred in seven patients. The mean IGF-1 increase on cabergoline was 1.7 ± 0.4 × ULN. Cabergoline dose reduction or interruption was attempted in five patients and resulted in decreased IGF-1 levels in all, including normalization in two patients. Three patients were eventually diagnosed with acromegaly, one was referred for pituitary surgery followed by complete remission, another patient was switched to somatostatin analogue, and the third was treated by combination of somatostatin analogues with pegvisomant, with reduction of IGF-1 in all these patients.
Conclusion
IGF-1 levels may increase to clinically significant levels during cabergoline treatment for PRL-adenoma. We suggest IGF-1 monitoring in all patients treated with dopamine agonists and not only in those presenting symptoms of acromegaly.
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A.A. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Amit Akirov, Ben Glaser, Irena S’chigol, Yossi Mansiterski, and Ilana Shraga-Slutzky: there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Ilan Shimon, has received research grants, consulting and lectureship fees from Novartis, Pfizer and Medison. Yona Greenman has received research grants, and consulting and lectureship fees from Novartis, Pfizer and Medison.
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Akirov, A., Greenman, Y., Glaser, B. et al. IGF-1 levels may increase paradoxically with dopamine agonist treatment for prolactinomas. Pituitary 21, 406–413 (2018). https://doi.org/10.1007/s11102-018-0891-5
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DOI: https://doi.org/10.1007/s11102-018-0891-5