Endocrine and Neuroendocrine Tumors
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Treatment of macroprolactinomas involves dopamine agonists in the first instance, principally cabergoline. Dopamine agonists should be initiated with the aim of lowering prolactin levels, decreasing tumor size, and causing a restoration of gonadal function.9 Cabergoline is the primary choice for patients due to its higher efficacy in normalizing prolactin levels and causing tumor shrinkage. In a systematic review, cabergoline achieved a 62% reduction in tumor size and 67% reduction in resolution of abnormal visual fields.11 It is administered once or twice a week at a dose of 0.5 mg, but a total weekly dose of up to 3 to 4 mg may occasionally be required in patients. Bromocriptine is an alternative treatment, but studies have shown that patient compliance with cabergoline is greater due to fewer side-effects, and bromocriptine needs to be taken at least once daily. Side-effects include nausea and dizziness, but these usually reduce over time, and it should be advised to take this medication with food. There have been reports that high doses of cabergoline, as used in Parkinson’s disease, may cause cardiac valvular problems, but if this occurs in patients with prolactinomas it is likely to be very rare; nevertheless, some authorities advise regular echocardiographic assessment. More importantly, “impulse control disorders” may present with pathological gambling, hypersexuality, or other psychopathological problems, and needs to be specifically queried in all patients on long-term dopamine agonists.12
Neuroendocrine disease
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
High-dose cabergoline (mean dose 5 mg/week), with prolonged treatment up to 12 months, has been reported to normalize prolactin in poor-responding patients.83 Cabergoline doses of 3 mg daily or more, however, have been reported to be associated with cardiac valvular fibrosis in patients with Parkinson’s disease.84,85 There have been several reported studies of cardiac function in patients treated with cabergoline for hyperprolactinemia and acromegaly. Most of these cases are cross-sectional. Although there have been some reports of mild, clinically nonsignificant valvular fibrosis, the evidence indicates that patients treated with the usual doses of cabergoline, ≤2mg/week, are not at risk of cardiac valvular fibrosis.13,17,86,87 Long-term prospective studies are required to confirm this hypothesis. Periodic echocardiography should be performed in patients who are found to have a cardiac murmur or in those treated with higher doses of cabergoline.
Helping women to ovulate
David J Cahill in Practical Patient Management in Reproductive Medicine, 2019
Treatment of raised prolactin due to a prolactinoma is generally medical in the first instance, using bromocriptine, a vinca alkaloid or a newer preparation, cabergoline. Cabergoline causes fewer side effects than bromocriptine (headaches being the most pronounced), but they both cause nausea and vomiting. Treatment will reduce prolactin almost immediately, though effects on the hypothalamic-pituitary-ovarian axis will not be evident for 6–8 weeks. If medical treatment is not successful, then a transsphenoidal hypophysectomy (removal of the pituitary, using a route up through the nasal passages and across the sphenoid sinus) may be required. This is a very destructive procedure and the patient will almost certainly need lifelong replacement of most if not all the pituitary hormones. If hyperprolactinemia is caused by medication prescribed by other medical specialties, ask the patient to seek advice from the prescriber as to alternatives.
Know Your Enemy: Potential Role of Cabergoline to Target Neoangiogenesis in Endometriosis
Published in Journal of Investigative Surgery, 2021
Antonio Simone Laganà, Simone Garzon, Jvan Casarin, Ricciarda Raffaelli, Antonella Cromi, Massimo Franchi, Fabio Ghezzi
In this scenario, cabergoline may represent a medication able to combine the antiangiogenetic effect with an adequate safety profile. Dopamine agonists are regularly used for the treatment of hyperprolactinemia and the inhibition of breastfeeding in the puerperium. Moreover, cabergoline is used for the prevention of ovarian hyperstimulation syndrome, where its action was related to the interference with the VEGF pathways by the dephosphorylation of VEGFR [7]. An effect of dopamine system on the VEGF pathways, and in general on angiogenesis, was further suggested by different pieces of evidence showing an induced angiogenesis by the ablation of peripheral dopaminergic nerves in mice, enhanced angiogenesis in knockout mice for the dopamine receptor 2 (DR2), and in vitro studies suggesting that the activation of DR2 induces the internalization of VEGFR2 [9].
Adrenal disorders in pregnancy, labour and postpartum – an overview
Published in Journal of Obstetrics and Gynaecology, 2020
Madhavi Manoharan, Prabha Sinha, Shabnum Sibtain
Medical treatment with anticortisolic drugs remains a second line of treatment (Lim et al. 2013; Touiti and Mghari 2015; Zieleniewski and Michalak 2017). The drugs commonly used are Metyrapone, Ketoconazole, Cyproheptidine, Amino-glutethemide, Mitotane and Cabergoline. They act by inhibiting steroid synthesis. Metyrapone is the most commonly used treatment with no side effects on maternal liver function or foetal development. This has been used in 69% of cases with good control of hyper cortisolism, in most of the cases (Lindsay et al. 2005; Blanco et al. 2006). However, Metyrapone can exacerbate high blood pressure and preeclampsia. Ketoconazole is not advisable in pregnancy because of risk of transplacental passage and its teratogenic and antiandrogenic effects on the fetus. (Berwaerts et al. 1999; Lindsay et al. 2005; Boronat et al. 2011). Mitotane and aminoglutethimide are also contraindicated during pregnancy because of risk of foetal masculinisation and teratogenicity (McClamrock and Adashi 1992). Cabergoline is not commonly used in pregnancy, unless the condition is persistent and recurrent (Woo and Ehsanipoor 2013; Nakhleh et al. 2016; Sek et al. 2017). Medical treatment with anticortisolic drugs could be reserved for special cases, with Metyrapone being the safest option. These drugs should be used with extreme caution in view of the low number of patients reported and limited experience with its use (Brue et al. 2018).
Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome?
Published in Gynecological Endocrinology, 2023
Nafiye Yilmaz, Pinar Gulsen Coban, Saynur Yilmaz, Hasan Ali Inal, Hakan Timur, Hacer Haltas
According to the American Society for Reproductive Medicine, there is good evidence that dopamine agonist administration starting at the time of hCG trigger reduces the incidence of OHSS [21]. However, in the majority of important human clinical studies assessing the effect of cabergoline, the reported evidence was not of high quality in terms of implantation rates, pregnancy rates or miscarriage rates. A review study of 858 women undergoing ART postulated that cabergoline was unlikely to affect clinical pregnancy, although the evidence was low-quality (RR 1.02, 95% CI 0.78–1.34, p = 0.86) [22]. In a Cochrane data analysis involving 16 randomized controlled trials, clinical pregnancy rates were comparable between placebo and intervention groups, the evidence being of moderate quality, although that analysis included not only cabergoline but also other two types of dopamine agonist (bromocriptine and quinagolide) (OR 0.81, 95% CI 0.54 to 1.22) [23].
Related Knowledge Centers
- Dopaminergic
- Hyperprolactinaemia
- Prolactinoma
- Parkinson's Disease
- Oral Administration
- Ergot
- Dopamine
- Dopamine Receptor D2
- Agonist
- Lactation Suppression