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Does hypopituitarism recover when macroprolactinomas are treated with cabergoline?
Niki Karavitaki1, Ruxandra Dobrescu, James V Byrne
1Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK. niki.karavitaki@ouh.nhs.uk
Clinical Endocrinology
|December 11, 2012
Summary
Cabergoline treatment for macroprolactinoma rarely reverses pituitary hormone deficits. Only the gonadotroph axis showed some recovery in patients achieving normal prolactin levels.
Area of Science:
- Endocrinology
- Neuroendocrinology
- Oncology
Background:
- Macroprolactinomas are pituitary tumors that secrete prolactin.
- Cabergoline is a dopamine agonist used to treat macroprolactinomas.
- Pituitary hormone deficits can occur in patients with macroprolactinomas.
Purpose of the Study:
- To evaluate the frequency and degree of recovery of anterior pituitary hormone deficits in patients with macroprolactinoma responsive to cabergoline.
- To assess the potential restoration of pituitary deficits after cabergoline treatment.
Main Methods:
- Retrospective review of patients with macroprolactinomas treated with cabergoline over a 2-year period.
- Assessment of pituitary function (GH, FSH/LH, ACTH, TSH axes) at diagnosis and annually for up to 3 years.
- Analysis of hormone deficit reversal rates.
Main Results:
- Eighty-three percent of patients had GH deficiency at diagnosis, with no recovery.
- Ninety percent had gonadotrophin deficiency at diagnosis, with 50% recovery at 1 year.
- ACTH deficiency (17%) and TSH deficiency (36%) showed limited or no reversal (25% for TSH).
Conclusions:
- Pituitary dysfunction in macroprolactinoma patients treated with cabergoline is largely irreversible.
- The gonadotroph axis is an exception, showing restoration in some patients after achieving normoprolactinemia.
- Reversibility of pituitary axes may be less common than previously assumed.
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