Clinical use of cabergoline as primary and adjunctive treatment for acromegaly

Background: Cabergoline is a dopamine agonist that may be used its primary or adjunctive therapy for acromegaly Although one study suggested biochemical control may be achieved in a substantial proportion of patients. it is still commonly perceived to be it relatively ineffective treatment. Design and method: A prospective audit was performed of 15 consecutive acromegalic patients (eight males, seven females, median age 55, range 31-92 at presentation) treated with cabergoline to determine the effective close and tolerability. All had normal anterior pituitary function: two patients had hyperprolactinaemia. Magnetic resonance imaging revealed nine adenomata. two partially empty, sellae and four structurally normal pituitary glands. Nine patients had undergone transsphenoidal surgery 1-12 months. and one patient had received pituitary radiotherapy 18 years. prior to commencement of cabergoline. All patients had biochemical excess: median serum IGF1 471 ng/ml, range 239-746 ng/ml. The calculated mean of a series of GH measurements ranged from 2.7-45.8 mIU/l, median 9.7 mIU/l. Results: On a median weekly dose of cabergoline of 1.75 mg (range 0.5-7 mg) normalisation of both IGF1 and GH occurred in 4 out of the 15 patients (27%). Out of the 15 patients (33%). 5 achieved a scrum IGF1 within the reference range with notable reductions seen in a further five patients. Nine patients (60%) achieved a mean serum GH level of less than 5 mIU/l. Duration of treatment was 2-52 months and was well tolerated ill 14 patients. Conclusion: Cabergoline can be an effective and well tolerated primary or adjunctive therapy for acromegaly and useful clinical responses are noted even with modest doses.