Navegando por Palavras-chave "Cabergoline"
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- ItemSomente MetadadadosRemission of acromegaly after treatment withdrawal in patients controlled by cabergoline alone or in combination with octreotide: results from a multicenter study(Springer, 2017) Casagrande, A. [UNIFESP]; Bronstein, M. D.; Jallad, R. S.; Mota, J. I.; Tabet, A.; Abucham, J. [UNIFESP]Purpose Remission of acromegaly has been reported after somatostatin analogs withdrawal, but not after withdrawal of combination therapy with cabergoline, and only in case reports of patients controlled by cabergoline alone. Methods To establish the remission rates (normal IGF-1 for age/sex: IGF-1 <= 1.00 xULN) after withdrawal of combined treatment with octreotide LAR and cabergoline and of cabergoline alone, we prospectively studied 16 patients with acromegaly controlled by those treatments in the preceding 2 years as part of a larger study on remission of acromegaly after withdrawal of different medical treatments. Results Among 97 patients with controlled acromegaly included in the entire study, only 16 patients had been on combination therapy (n = 12) or cabergoline alone (n = 4). At 8 weeks after treatment withdrawal, three patients (19%) were in remission (short-term remission). At 60 weeks (long-term remission), IGF-1 levels were still in the normal range in two patients (12.5%) and remained normal up to 108 weeks after treatment withdrawal (last visit). One patient had been treated with cabergoline alone and another one with combination of octreotide and cabergoline before treatment withdrawal. Conclusion Remission of acromegaly after treatment withdrawal seems to be uncommon in patients controlled by cabergoline, either as monotherapy or in combination with octreotide. In the future, larger studies and/or meta-analysis will be necessary to accurately establish the remission rates of acromegaly after withdrawal of cabergoline with or without somatostatin analogs.
- ItemSomente MetadadadosResposta da prolactina à metformina em prolactinomas resistentes à cabergolina: um estudo piloto(Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Portari, Luiz Henrique Correa [UNIFESP]; Abucham Filho, Julio Zaki [UNIFESP]; Universidade Federal de São PauloContext: Cabergoline is the treatment of choice for prolactinomas. However, 10-20% of prolactinomas are resistant to cabergoline. Metformin, a biguanide widely used in the treatment of diabetes mellitus, has been shown to reduce prolactin secretion in various pituitary tumor cell lineages both in vitro and in vivo and in human pituitary adenomas in vitro. Objective: To test the effects of metformin addition to cabergoline treatment on prolactin levels in patients with resistant prolactinomas. Design: Prospective. Setting: Outpatient clinic in a reference center. Patients: Ten adult patients (26-61 y) with prolactinomas (7M), persistent hyperprolactinemia (38-386 ng/ mL) under cabergoline treatment (2-7 mg/week), at least six months of treatment (6- 108 mo), and features of metabolic syndrome were included. Intervention: Metformin (1.0-2.5 g v.o./d) was given according to patients´ tolerance. Cabergoline doses were kept unchanged. Main Outcome Measure: Serum prolactin levels were measured before and after short- (30-60 d) and long- term (120-180 d) metformin treatment. Results: Mean prolactin levels did not show any significant changes (148 ± 39 ng/ml vs 138 ± 42 ng/ml vs 133 ± 39 ng/ml, before, at 30-60 days, and at 120- 180 days, respectively, P=0.196) after metformin (mean dose: 1.25 g/day; range: 1.0- 2.0 g/day). No patient reached a normal prolactin level during metformin treatment. Two patients were considered partial responders for exhibiting prolactin decreases ≥50% at a single time point during metformin. Conclusions: Metformin addition to ongoing high dose cabergoline treatment in patients with cabergoline-resistant prolactinomas failed to show a consistent inhibitory effect in serum prolactin levels.
- ItemSomente MetadadadosShort- and Long-Term Efficacy of Combined Cabergoline and Octreotide Treatment in Controlling IGF-I Levels in Acromegaly(Karger, 2010-01-01) Mattar, Priscilla; Alves Martins, Manoel Ricardo; Abucham, Julio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Nearly 40% of acromegalic patients fail to control GH/IGF-I levels with somatostatin analogues (SA). Dopaminergic agonists (DA) are even less effective, but combination therapy with SA and DA normalizes IGF-I levels in 33-56% of patients not controlled by octreotide alone in short-term studies. This study was designed to evaluate short-and long-term efficacy of cabergoline in controlling IGF-I levels in acromegalic patients receiving octreotide. Design: Open-label, single arm, prospective trial. Nineteen patients (14 females, 29-78 years of age) with high IGF-I on octreotide-LAR (30 mg/month IM) for >= 6 months were enrolled. Study I: Cabergoline (PO) was started at 1.0, increased to 2.0 and 3.5 mg/week, and withdrawn at 6-week intervals. IGF-I, GH, and PRL were measured at baseline and at 6-week intervals. Study II: Responder patients (IGF-I <= 1 ULN) resumed cabergoline at individual lowest effective doses and were evaluated at 6-month intervals for >= 12 months. Study III: Responders were withdrawn from octreotide and hormonally evaluated at 3-month intervals. Methods: Serum IGF-I (IRMA), GH (ICMA) and PRL (ICMA) levels were determined by commercially available kits. Results: Addition of cabergoline to octreotide-LAR normalized IGF-I levels in 7 of 19 patients (37%) during both short-and long-term follow-up (12-27 months, mean: 18 months). Octreotide withdrawal increased IGF-I levels in only 2 of 6 responder patients. Normalization of IGF-I levels by cabergoline was strongly associated with IGF-I <= 2.2 ULNR and/or GH <= 4.0 ng/ml under octreotide treatment. Conclusion: Addition of cabergoline to octreotide was effective in both short-and long-term control of IGF-I in acromegaly, especially in patients with mild/moderately elevated GH/IGF-I levels during octreotide. Copyright (C) 2010 S. Karger AG, Basel