Long-term IGF-1 monitoring in prolactinoma patients treated with cabergoline might not be indicated
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ORIGINAL ARTICLE
Long-term IGF-1 monitoring in prolactinoma patients treated with cabergoline might not be indicated Lukas Andereggen
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Janine Frey3 Emanuel Christ4 ●
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Received: 27 August 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Cabergoline (CAB) therapy for prolactinomas has been associated with serum IGF-1 levels modifications, with recent reports indicating a paradoxical increase of IGF-1 levels during ongoing therapy. As a result, IGF-1 measurement has been proposed not only at diagnosis of a prolactinoma, but also during follow-up. In this follow-up study on prolactinoma patients with chronic CAB therapy, we investigated whether there are long-term changes in IGF-1 levels that necessitate continuous monitoring. Methods We reviewed our institutional database on prolactinoma patients with long-term CAB therapy, in whom IGF-1 levels were measured at baseline, at 3-months follow-up and in the long term. Results Chronic CAB therapy was noted in 20 patients (13 men, 7 women). Median (±SD) age was 43.5 ± 12.6 years. 17 (85%) patients presented with a macroprolactinoma. Median CAB treatment time was 75 ± 43 months (range 24–187). Median IGF-1 levels increased at last follow-up, though not significantly; from 122 ± 37 ng/ml (IQR 104–160 ng/ml) to 133 ± 54 (IQR 121–162 ng/ml), p = 0.10. Thereby, 18 (90%) patients showed normal serum IGF-1 levels adjusted for age, one (5%) patient above (1.05 × ULN) and 1 (5%) patient below the normal range (0.34 × ULN). No patient was or became symptomatic of acromegaly. Conclusion Our long-term results indicate that chronic treatment with CAB in prolactinoma patients does not significantly modify serum IGF-1 levels. Bearing in mind the sample size of this study, continuing IGF-1 monitoring is not indicated in prolactinoma patients with long-term CAB therapy. Keywords IGF-1 Dopamine agonists Cabergoline Prolactinoma Long-term follow-up ●
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Background Dopamine agonists (DAs) are the first-line approach in the treatment of prolactinomas [1–3], with cabergoline (CAB) being the first choice given its potency and low side-effect
* Lukas Andereggen [email protected] 1
Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster Inselspital, Bern University Hospital, Bern, Switzerland
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Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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Department of Gynecology and Obstetrics, Kantonsspital Lucerne, Lucerne, Switzerland
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Department of Endocrinology, Diabetology and Metabolism, University Hospital of Basel, Basel, Switzerland
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profile [4]. With CAB, hyperprolactinemia is controlled in the majority of patients [5], yet treatment is lifelong in up to 80% of patients [6]. In addition, in contrast to initial studies reporting that many patients treated with CAB remained in remission after drug withdrawal [7], later reports have described early recurrence of hyperprolactinaemia following drug discontinuation, in particular i
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