Amit Akirov1,2, Yona Greenman3,4, Benjamin Glaser5, Irena S'chigol6, Yossi Mansiterski3,7, Yoav Eizenberg3,8, Ilana Shraga-Slutzky9,3, Ilan Shimon9,3. 1. Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, 4941492, Petach Tikva, Israel. amit.akirov@gmail.com. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. amit.akirov@gmail.com. 3. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 5. Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel. 6. Clalit Health Care Services, Tel Aviv, Israel. 7. Maccabi Health Care Services, Tel Aviv, Israel. 8. Tel Aviv-Jaffa District Clalit Health Services, Tel Aviv, Israel. 9. Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, 4941492, Petach Tikva, Israel.
Abstract
OBJECTIVE: Hyperprolactinemia is common in acromegaly and in these patients, insulin-like growth factor (IGF)-1 level may decrease with dopamine agonist. We report a series of patients with prolactinoma and a paradoxical increase of IGF-1 levels during cabergoline treatment. METHODS: Clinical characteristics and response to treatment of patients with prolactinomas, in whom normal or slightly elevated baseline IGF-1 levels increased with cabergoline. RESULTS: The cohort consisted of ten prolactinoma patients (nine males, mean age 48 ± 14 years). Mean adenoma size was 23.8 ± 16.2 mm, with cavernous sinus invasion in eight. In five patients baseline IGF-1 levels were normal and in four levels were 1.2-1.5-fold the upper limit of the normal (ULN). One patient had IGF-1 measured shortly after initiating cabergoline and it was 1.4 × ULN. During cabergoline treatment (dose range 0.5-2 mg/week) PRL normalization was achieved in all and tumor shrinkage occurred in seven patients. The mean IGF-1 increase on cabergoline was 1.7 ± 0.4 × ULN. Cabergoline dose reduction or interruption was attempted in five patients and resulted in decreased IGF-1 levels in all, including normalization in two patients. Three patients were eventually diagnosed with acromegaly, one was referred for pituitary surgery followed by complete remission, another patient was switched to somatostatin analogue, and the third was treated by combination of somatostatin analogues with pegvisomant, with reduction of IGF-1 in all these patients. CONCLUSION: IGF-1 levels may increase to clinically significant levels during cabergoline treatment for PRL-adenoma. We suggest IGF-1 monitoring in all patients treated with dopamine agonists and not only in those presenting symptoms of acromegaly.
OBJECTIVE:Hyperprolactinemia is common in acromegaly and in these patients, insulin-like growth factor (IGF)-1 level may decrease with dopamine agonist. We report a series of patients with prolactinoma and a paradoxical increase of IGF-1 levels during cabergoline treatment. METHODS: Clinical characteristics and response to treatment of patients with prolactinomas, in whom normal or slightly elevated baseline IGF-1 levels increased with cabergoline. RESULTS: The cohort consisted of ten prolactinomapatients (nine males, mean age 48 ± 14 years). Mean adenoma size was 23.8 ± 16.2 mm, with cavernous sinus invasion in eight. In five patients baseline IGF-1 levels were normal and in four levels were 1.2-1.5-fold the upper limit of the normal (ULN). One patient had IGF-1 measured shortly after initiating cabergoline and it was 1.4 × ULN. During cabergoline treatment (dose range 0.5-2 mg/week) PRL normalization was achieved in all and tumor shrinkage occurred in seven patients. The mean IGF-1 increase on cabergoline was 1.7 ± 0.4 × ULN. Cabergoline dose reduction or interruption was attempted in five patients and resulted in decreased IGF-1 levels in all, including normalization in two patients. Three patients were eventually diagnosed with acromegaly, one was referred for pituitary surgery followed by complete remission, another patient was switched to somatostatin analogue, and the third was treated by combination of somatostatin analogues with pegvisomant, with reduction of IGF-1 in all these patients. CONCLUSION:IGF-1 levels may increase to clinically significant levels during cabergoline treatment for PRL-adenoma. We suggest IGF-1 monitoring in all patients treated with dopamine agonists and not only in those presenting symptoms of acromegaly.
Authors: Felipe F Casanueva; Mark E Molitch; Janet A Schlechte; Roger Abs; Vivien Bonert; Marcello D Bronstein; Thierry Brue; Paolo Cappabianca; Annamaria Colao; Rudolf Fahlbusch; Hugo Fideleff; Moshe Hadani; Paul Kelly; David Kleinberg; Edward Laws; Josef Marek; Maurice Scanlon; Luis G Sobrinho; John A H Wass; Andrea Giustina Journal: Clin Endocrinol (Oxf) Date: 2006-08 Impact factor: 3.478
Authors: Laurence Katznelson; Edward R Laws; Shlomo Melmed; Mark E Molitch; Mohammad Hassan Murad; Andrea Utz; John A H Wass Journal: J Clin Endocrinol Metab Date: 2014-10-30 Impact factor: 5.958