Document Detail


Individualized high-dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas.
MedLine Citation:
PMID:  20357175     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Cabergoline is effective for hyperprolactinemic hypogonadism. However, the rate of cabergoline-induced pregnancy in women with prolactinoma remains unknown. Also unknown is whether cabergoline can control tumor growth and thereby achieve successful pregnancy in patients with macroprolactinomas.
METHODS: Eighty-five women with macroprolactinomas (n = 29) or microprolactinomas (n = 56) received prospective, high-dose cabergoline therapy for infertility based on individual prolactin suppression and/or tumor shrinkage. The patients included 31 bromocriptine-resistant, 32 bromocriptine-intolerant, and 22 previously untreated women. Conception was withheld until three regular cycles returned in women with microadenoma and until tumors shrank below 1.0 cm in height in women with macroadenoma. Cabergoline was withdrawn at the fourth gestational week.
RESULTS: Cabergoline normalized hyperprolactinemia and recovered the ovulatory cycle in all patients. All adenomas contracted, and 11 macroadenomas and 29 microadenomas disappeared. Eighty patients (94%) conceived 95 pregnancies, two of which were cabergoline-free second pregnancies. The dose of cabergoline at the first pregnancy was 0.25-9 mg/wk overall and 2-9 mg/wk in the resistant patients. Of the 93 pregnancies achieved on cabergoline, 86 resulted in 83 single live births, one stillbirth, and two abortions; the remaining seven were ongoing. All babies were born healthy, without any malformations. No mothers experienced impaired vision or headache suggestive of abnormal tumor reexpansion throughout pregnancy.
CONCLUSION: Cabergoline achieved a high pregnancy rate with uneventful outcomes in infertile women with prolactinoma, independent of tumor size and bromocriptine resistance or intolerance. Cabergoline monotherapy could substitute for the conventional combination therapy of pregestational surgery or irradiation plus bromocriptine in macroprolactinomas.
Authors:
Masami Ono; Nobuhiro Miki; Kosaku Amano; Takakazu Kawamata; Toshiro Seki; Rena Makino; Kazue Takano; Shun-ichiro Izumi; Yoshikazu Okada; Tomokatsu Hori
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Publication Detail:
Type:  Journal Article     Date:  2010-03-31
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  95     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-07     Completed Date:  2010-07-01     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2672-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine II, Institute of Clinical Endocrinology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Birth Weight
Bromocriptine / adverse effects,  therapeutic use
Cohort Studies
Dopamine Agonists / adverse effects,  therapeutic use*
Drug Resistance
Ergolines / adverse effects,  therapeutic use*
Female
Humans
Hyperprolactinemia / complications*,  drug therapy*
Infertility, Female / drug therapy*,  etiology*
Magnetic Resonance Imaging
Pituitary Neoplasms / complications*,  pathology
Pregnancy
Pregnancy Complications / epidemiology
Pregnancy Outcome
Progesterone / blood
Prolactin / blood
Prolactinoma / complications*,  pathology
Chemical
Reg. No./Substance:
0/Dopamine Agonists; 0/Ergolines; 25614-03-3/Bromocriptine; 57-83-0/Progesterone; 9002-62-4/Prolactin; LL60K9J05T/cabergoline
Comments/Corrections
Comment In:
Nat Rev Endocrinol. 2010 Aug;6(8):415   [PMID:  20681039 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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