Endocrine Abstracts (2010) 22 P240

Synergic effect of Cabergoline in acromegaly treated with somatostatin analogues. Report of two cases

Miguel Paja, Josu Pérez-Yéboles, Aitzol Lizarraga, Cristina Moreno, Ana Isusquiza & J Ramón Elorza

Hospital de Basurto, Basque Country, Bilbao, Spain.

Current treatment for acromegaly includes dopamine agonists (DA), somatostatin receptor ligands (SRL) and GH receptor antagonists (GHRA). DA in monotherapy, is less than 10% effective achieving control of the disease, and its efficacy in addition to ongoing SRL is less studied, without obvious determining factors of response. We report 2 operated patients with incomplete response to SRL and to whom Cabergoline addition led to disease control.

Case 1: A man 36 years old was transesphenoidally operated of an intrasellar GH producing macroadenoma. Basal GH and after glucose (OGTT; GHOGTT) was 16.1 and 16.2 ng/ml, and IGFI 907 ng/ml (N <284). Four months after surgery GHOGTT was 5.4 ng/ml and IGFI 708 ng/ml. Treatment with Octreotide, 20 mg every 4 weeks, reduced GHOGTT 2.81 and IGFI to 470. Addition of Cabergoline began with 1 mg leading to 1.5 mg per week, obtaining reduction of IGFI under upper limit for age, with nadir of 113 ng/ml and basal GH of 0.2 ng/ml.

Case 2: A man 57 years old with long term acromegaly presented GHOGTT of 48 ng/ml, IGFI of 846 ng/ml, and normal prolactin. MRI showed a macroadenoma with right cavernous invasion. After surgery GHOGTT reduced to 5.15 and IGFI to 506. Treatment with Somatuline Autogel (120 mg monthly) got a GHOGTT of 1.11 and IGFI of 207. Addition of Cabergoline (up to 3 mg/week) reduced GHOGTT to 0.62 and IGFI to 140 with reduction in Somatuline to 90 mg/week. Employed drugs were well tolerated in both cases.

Combined treatment of SRL and DA resulted in control of the disease. Both reached most restrictive criteria of control (GHOGTT < 1 ng/ml and levels of IGFI under upper limits for age). One case could benefit lower dose of SRL.

The association of Cabergoline and SRL deserves a relevant role in the acromegaly treatment. It might be tried sistematically before the expensive use of Pegvisomant.

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