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Dynamic changes in IGF-1 levels during cabergoline therapy in prolactinoma
Ahmet Numan Demir1, Alara Birol2, Dilan Ozaydin3
1Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Background:
Cabergoline, a dopamine agonist widely used in prolactinoma treatment, also suppresses growth hormone (GH) and insulin-like growth factor-1 (IGF-1), though its long-term effects on IGF-1 levels in prolactinoma remain unclear.
Objective:
To evaluate changes in IGF-1 levels and influencing factors in prolactinoma patients treated with cabergoline.
Methods:
This retrospective cohort study included 127 prolactinoma patients treated with cabergoline between 2013 and 2023. Patients with conditions affecting IGF-1 (e.g., hypopituitarism, organ dysfunction, hormone replacement therapy) were excluded. IGF-1 and IGF-1xULN levels were compared at baseline and last follow-up. Associations with treatment duration, cumulative cabergoline dose, and tumor features were assessed using regression and ROC analyses.
Results:
The median follow-up was 36 [IQR: 18-60] months. Final IGF-1 and IGF-1xULN levels were significantly lower than baseline (p = 0.002 and p = 0.045). IGF-1xULN increased in 44.9 % and decreased in 55.1 % of patients, but all values remained within normal limits. Decreased IGF-1xULN was associated with longer treatment duration and higher cumulative doses (p < 0.05). ROC analysis identified ≥60 mg cumulative dose and ≥ 18 months treatment duration as predictors of IGF-1 reduction (AUROC ≈ 0.70).
Conclusion:
Cabergoline therapy in prolactinoma may result in an early rise and subsequent decline in IGF-1 levels. The clinical significance of within-range IGF-1 reductions remains uncertain and requires prospective studies with predefined metabolic endpoints.
Insights
Cabergoline treatment for prolactinoma may initially increase then decrease insulin-like growth factor-1 (IGF-1) levels. Longer treatment and higher doses correlate with IGF-1 reduction, though clinical significance requires further study.
Area of Science:
- Endocrinology
- Pharmacology
- Oncology
Background:
- Cabergoline is a dopamine agonist used for prolactinoma.
- Its long-term effects on insulin-like growth factor-1 (IGF-1) in prolactinoma patients are not well understood.
- Cabergoline is known to suppress growth hormone (GH) and IGF-1.
Purpose of the Study:
- To assess changes in IGF-1 levels in prolactinoma patients receiving cabergoline.
- To identify factors influencing these IGF-1 level changes.
- To evaluate the relationship between cabergoline dosage, treatment duration, and IGF-1 levels.
Main Methods:
- Retrospective cohort study of 127 prolactinoma patients treated with cabergoline (2013-2023).
- Exclusion of patients with conditions affecting IGF-1.
- Comparison of IGF-1 and IGF-1xULN levels at baseline and last follow-up.
- Regression and ROC analyses to assess associations with treatment duration, cumulative dose, and tumor features.
Main Results:
- Median follow-up was 36 months.
- Final IGF-1 and IGF-1xULN levels were significantly lower than baseline (p < 0.05).
- Decreased IGF-1xULN was linked to longer treatment duration and higher cumulative cabergoline doses (p < 0.05).
- Predictors for IGF-1 reduction included cumulative dose ≥60 mg and treatment duration ≥18 months.
Conclusions:
- Cabergoline therapy for prolactinoma may cause an initial rise followed by a decline in IGF-1 levels.
- Reductions in IGF-1, even within normal limits, require further investigation.
- Prospective studies with defined metabolic endpoints are needed to clarify the clinical significance.
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