Efficacy and safety of cabergoline as first line treatment for invasive giant prolactinoma

Abstract

Although cabergoline is effective in the treatment of micro- and macro-prolactinoma, little is known about its efficacy in the treatment of invasive giant prolactinoma. We investigated the efficacy and safety of cabergoline in 10 male patients with invasive giant prolactinoma. Before treatment, mean serum prolactin level was 11,426 ng/mL (range, 1,450-33,200 ng/mL) and mean maximum tumor diameter was 51 mm (range, 40-77 mm). Three months after initiation of cabergoline treatment, serum prolactin concentrations decreased more than 97% in 9 patients; at last follow-up (mean treatment duration, 19 months), the mean decrease in serum prolactin concentrations was 98%, with 5 patients having normal serum prolactin levels. At first MRI follow-up (3-12 months after initiation of cabergoline), the mean reduction in tumor size was 85+/-4% (range, 57-98%). Cabergoline treatment for more than 12 months caused a greater reduction in tumor size compared to the treatment for less than 12 months (97+/-1% vs. 78+/-7%, P<0.05). These findings indicate that cabergoline treatment led to a significant and rapid reduction in serum prolactin concentrations and tumor size in patients with giant prolactinoma. Therefore, cabergoline represents an effective and well-tolerated treatment for invasive giant prolactinoma.

Keywords: Cabergoline; Invasive Giant Prolactinoma; Male; Prolactin; Tumor Size.

Fig. 1

Serum prolactin concentrations before and during cabergoline treatment in 10 men with invasive giant prolactinoma.

Fig. 2

Serial follow-up of gadolinium-enhanced T1 weighted magnetic resonance imaging before and during cabergoline treatment. Four patients had giant prolactinoma with cavernous sinus invasion and suprasellar and infrasellar extension before treatment. Significant tumor shrinkage was induced by cabergoline treatment. Tx, treatment; mo, months.