Endocrine Abstracts (2019) 65 P292 | DOI: 10.1530/endoabs.65.P292

Cabergoline in the treatment of acromegaly: experience from a large pituitary centre

Irene Samperi1,2,3, Kirstie Lithgow1,2,3, Shu Teng Chai1,2,3, Miriam Asia2,3, Shahzada Ahmed4, Alessandro Paluzzi5, George Tsermoulas5, Sara Meade6, Paul Sanghera6, Andy Toogood2,3, Neil Gittoes1,2,3, John Ayuk2,3 & Niki Karavitaki1,2,3


1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, Birmingham, UK; 3Department of Endocrinology Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK; 4Department of Ear, Nose and Throat Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK; 5Department of Neurosurgery Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK; 6Department of Oncology Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK


Introduction: Cabergoline is one of the medical treatments in acromegaly; it can be used alone or in combination with other available agents.

Aim: To review the efficacy of cabergoline in patients with acromegaly treated in our centre.

Patients and methods: Patients with acromegaly on cabergoline were identified from our Pituitary Registry. Clinical/laboratory/imaging data were collected and analysed.

Results: Follow-up data were available for 42 patients [25 males, 16 received cabergoline monotherapy and 26 cabergoline combined with somatostatin analogue (n=24) or pegvisomant (n=2)].

Monotherapy group: 10 patients had surgery and 3 radiotherapy prior to cabergoline. Median baseline (prior cabergoline) IGF-I 139% ULN (102−253%). Cabergoline dose: median 2 mg/week (0.25−4); median duration of treatment 31 months (5−107). At last follow-up: median IGF-I 112% ULN (48−160%); normal IGF-I was achieved in 7 (44%) patients. Cabergoline and somatostatin analogue group: 18 patients had surgery and 15 radiotherapy prior to medical treatment. 15 had octreotide LAR and 9 lanreotide. Median baseline (prior cabergoline) IGF-I 175% ULN (128−292%). Cabergoline dose: median 1.5 mg/week (0.5−3.5); median duration of treatment 31 months (11−117). At last follow-up: median IGF-I 136% ULN (range 64−244%); normal IGF-I was achieved in 6 (23%) patients.

Cabergoline and pegvisomant group: Both patients had surgery and radiotherapy prior to medical treatment. Median pegvisomant dose 38 mg/day (7.5−30 mg). Baseline (prior cabergoline) IGF 158% ULN (available for one patient). Cabergoline dose: median 2.75 mg/week (2−3.5 mg). At last follow-up: median IGF-I 130% ULN (110−150%); normal IGF-I was achieved in no patient. Four patients reported mild adverse effects (nausea, dizziness, or nasal congestion) whilst on the dopamine agonist.

Conclusions: In our series, cabergoline offered as monotherapy in patients with biochemically mild acromegaly was highly effective. In contrast to previous published experience, the results were less optimal when combined with somatostatin analogue treatment.