Endocrine Abstracts (2002) 3 P148

Primary medical management of macroprolactinomas with cabergoline(CAB)

S Philip1, A Booth1, P Abraham1, M Kumaravel2, WA Watson1, CM Park1, S Bandyopadhyay1, SH Acharya1 & JS Bevan1

1Department of Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK; 2Department of Radiodiagnosis, Aberdeen Royal Infirmary, Aberdeen, UK.

Objective: To establish the efficacy of CAB as primary and exclusive therapy in the management of macroprolactinomas

Method: Retrospective case note review of all patients with macroprolactinomas treated with CAB since the drug received a UK licence in 1994. Patients: Sixteen patients (8males, 8 females) with mean age at presentation of 42.3yrs (range 22-72 years) were treated with initial CAB doses ranging from 0.5-1mg/week (median 1mg/week). Results: The most common symptoms in men were headache (75%), visual field defects (63%) and loss of libido (63%). The most common symptoms in women were headache (50%), amenorrhoea (37.5%), oligomenorrhoea (37.5%) and galactorrhoea (38%). Maximum doses of CAB used ranged from 0.5-2 mg/week (median 1mg/week). There were significant falls in mean PRL levels (P < 0.05) with median values of 21704 mu/l (range 1256-821000), 1849 (39-48000), 1323 (39 -33000), 286 (39 - 19800) at start, one month, six months and one year of therapy respectively.PRL normalisation of prolactin level were achieved in 7 patients (43 %) after one year. There was good symptomatic relief with improvement in libido in 3 of 5 patients (60%), 100% restoration of regular menstrual cycles in premenopausal women(n=6), 4 of 5 patients (80%) had resolution of galactorrhoea, 5 of 6 patients (83%) showed improvement in visual fields and 6 of 8 patients (75%) patients were relieved of headache.Fourteen of 16 patients (87.5%) showed at least 25% reduction in tumour size within 6 months of treatment. Conclusion: Primary medical management with cabergoline is a convenient and effective treatment for macroprolactinomas.

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