Cabergoline treatment reduces androgen levels and restores menstrual cycles in women with hyperprolactinemic polycystic ovary syndrome

Aslı Sığınır; Hayri Bostan; Saygili Emre Sedar; Ceren Tufan; Ersen Karakilic

doi:10.1530/endoabs.110.EP1370

JOINT2062

Purpose: Cabergoline is widely used to treat hyperprolactinemia, but its effects on polycystic ovary syndrome (PCOS) remain unclear. Since hyperprolactinemia is present in nearly 30% of PCOS cases, this study aims to assess the impact of cabergoline on androgen levels and clinical outcomes in hyperprolactinemic PCOS (hPCOS)cases, discussing these findings with the results in prolactinoma cases.

Methods: A total of 66 women aged 18 to 40 were included in this retrospective cohort study, with 36 in the PCOS group(median 24.0(22.0-27.5) years) and 30 in the prolactinoma group(median 28.0(23.7-33.0) years). Only patients who had been started on cabergoline treatment and had available follow-up data were included. Hormonal profiles and clinical findings, including hirsutism and menstrual cycle regularity, were assessed before and after cabergoline treatment.

Results: After cabergoline treatment, significant reductions in prolactin and total testosterone levels were observed in both hPCOS and prolactinoma groups. In the hPCOS group, total testosterone decreased from 0.65 to 0.49 ng/ml (p<0.001) and dehydroepiandrosterone-sulphate levels from 407.5 to 301.0 µg/dl (p<0.001)(Table-1). In the prolactinoma group, total testosterone decreased from 0.39 to 0.29 ng/ml (p<0.001) (Table-2). Menstrual irregularities improved markedly in both groups, with prevalence decreasing from 83.3% to 5.6% in hPCOS group and from 80.0% to 10.0% in the prolactinoma group(p<0.001). Furthermore, in hPCOS group, the prevalence of hirsutism was decreased from 86.1% to 61.1%(p=0.007).

Table 1. Comparison of clinical and laboratory parameters in PCOS cases before and after cabergoline.
	Before treatment (n = 36)	After treatment (n = 36)	P-value
DHEA-S(ug/dl), median (IQR)	407.5(247.5-534.2)	301.0(210.7-405.7)	<0.001
Total Testosteron(ng/ml), median (IQR)	0.65(0.54-0.85)	0.49(0.32-0.58)	<0.001
Estradiol(pg/ml), median (IQR)	55.0(45.0-90.0)	67.5(45.7-113.2)	0.15
FSH(mIU/ml), median (IQR)	6.3(5.5-7.4)	5.3(4.1-6.5)	0.06
LH(mIU/ml), median (IQR)	10.6(7.2-16.0)	10.6(7.2-18.0)	0.66
TSH(uIU/ml), median (IQR)	2.6(1.9-3.1)	2.1(1.2-2.8)	0.05
Prolactin(ng/ml), median (IQR)	40.0(28.2-61.5)	1.1(0.4-11.2)	<0.001
Insulin(uIU/ml), median (IQR)	10.7(8.1-14.0)	11.5(8.3-12.8)	0.60
Glucose(mg/dl), median (IQR)	87.0(82.7-93.0)	89.0(84.0-93.5)	0.39
HOMA-IR, median(IQR)	2.49 1.67-3.01)	2.49(1.48-2.83)	0.90
Hirsutism, n(%)	31(86.1)	22(61.1)	0.007
Menstrual irregularity, n(%)	30(83.3)	2(5.6)	<0.001
Acne, n(%)	8(22.2)	7(19.4)	0.56

Table 2. Comparison of clinical and laboratory parameters in prolactinoma cases before and after cabergoline.
	Before treatment (n = 30)	After treatment (n = 30)	P-value*
DHEA-S(ug/dl), median(IQR)	227.0(206.0-400.5)	249.5(136.5-344.2)	0.19
Total Testosteron(ng/ml), median(IQR)	0.39(0.22-0.50)	0.29(0.20-0.36)	<0.001
Estradiol(pg/ml), median(IQR)	61.0(37.5-135.5)	93.5(62.0-144.2)	0.12
FSH(mIU/ml), median(IQR)	6.1(3.8-8.4)	5.1(4.1-8.7)	0.65
LH(mIU/ml), median(IQR)	8.7(5.6-10.8)	9.6(6.7-14.6)	0.07
TSH(uIU/ml), median(IQR)	2.7(1.47-3.1)	2.6(1.67-3.2)	0.45
Prolactin(ng/ml), median(IQR)	57.0(39.0-99.5)	10.0(2.0-17.5)	<0.001
Insulin(uIU/ml), median(IQR)	14.0(4.8-19.4)	10.3(8.0-20.7)	0.18
Glucose (mg/dl), median(IQR)	94.0(91.0-96.0)	93.0(86.2-101.0)	0.18
HOMA-IR, median(IQR)	3.20(1.08-4.74)	2.30(1.65-4.76)	0.18
Hirsutism, n(%)	5(16.7)	3(10.0)	0.16
Menstrual irregularity, n(%)	24(80.0)	3(10.0)	<0.001

Conclusion: Cabergoline is effective in lowering prolactin and androgen levels while improving menstrual regularity in both hPCOS and prolactinoma patients, highlighting its potential as a valuable therapeutic option for PCOS.

Endocrine Abstracts

EP1370