High-dose Cabergoline Treatment of Childhood- and Adolescence-onset Prolactinomas

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-111
Nobuhiro Miki*, Masami Ono, Yasufumi Seki, Rena Makino and Atsuhiro Ichihara
Context: Although pituitary adenoma occurs less commonly in children than in adults, the most common pituitary adenoma in children is prolactin-secreting adenoma in contrast to non-functioning pituitary adenoma in adults. It is not well known, however, whether the first-choice dopamine agonist cabergoline is as effective in children as in adults.

Objective: We prospectively conducted high-dose cabergoline therapy to treat patients with prolactinoma of childhood and adolescence onset.

Methods: Patients were 14 females and 8 males diagnosed at the age of 6-18 years. Initial symptoms were visual impairment in 8 cases, headache in 4 cases, short stature in 8 cases, galactorrhea in 9 cases, primary amenorrhea or irregular menses in 14 cases, delayed puberty in 4 cases. Ten of the 14 females and all of the 8 males had macroadenoma, of which 8 were giant adenoma > 3.0cm in height, and the remaining 4 females had microadenoma. As prior therapy, bromocriptine had been given as monotherapy in 2 patients or as an adjunctive therapy after surgery in 8 patients, but failed to normalize hyperprolactinemia in any subject in either situation. Cabergoline was started at a standard dose of 0.25 mg twice weekly and doses were escalated at 2-4 week intervals on the basis of individual prolactin responsiveness up to 9 mg per week. Length of treatment was longer than 12 months except 3 subjects.

Results: Mean serum prolactin level was 1422 μg/L (n = 21) at diagnosis and 813 μg/L (n = 22) before cabergoline therapy. Cabergoline suppressed hyperprolactinemia in all patients and normalized it in 17 (82.6 %) of 22 patients. Hypogonadism was recovered in all patients except four subjects who had received craniotomy or transsphenoidal surgery once or twice to remove giant adenoma or macroadenoma. The final cabergoline doses equal to or greater than 2 or 3 mg/week were required in 17 (77 %) or 13 (59 %) patients, respectively, and the maximum dose of 9 mg/week was administered in 5 (23 %) subjects. More than 1-2 years after cabergoline treatment, adenomas shrank more than a half the pretreatment volume in all patients except one and disappeared in five subjects on magnetic resonance imaging. Adverse events were transient dizziness and constipation in one and three patients, respectively, and there was no valvulopathy on echocardiography in any patient.

Conclusion: A majority of prolactinoma in children and adolescents are cabergoline-resistant requiring at least 2-mg/week doses, but cabergoline can break through drug resistance if used at a sufficient dosage to bring favorable outcomes in most of these prolactinoma patients.

Nothing to Disclose: NM, MO, YS, RM, AI

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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