Pergolide as primary therapy for macroprolactinomas.
Orrego JJ, Chandler WF, Barkan AL.
Department of Surgery, University of Michigan Medical Center and Department of Veterants Affairs Medical Center, Ann Arbor 48109, USA.
The objective of this study is to determine whether pergolide therapy is an effective modality for the de novo treatment of patients with macroprolactinomas. Twenty-two consecutive patients with macroprolactinomas were included in the study and followed prospectively. These included 16 men and 6 women in whom pregnancy was not of concern. Pergolide was administered once or twice a day depending on the patient's preference. Ten patients received 0.1 mg daily as a maintenance regimen and in the others the daily dose ranged from 0.05 to 0.5 mg. Eight patients reported minor but tolerable side effects. One patient had to be switched to cabergoline because of intolerable nausea. After a mean of 12 months (range, 3-36), mean PRL levels declined from 3,135 ng/ml (range, 126-31,513) to 50 ng/ml (3-573), representing a mean PRL suppression of 88% (range, 0-99). PRL levels became normal in 15 patients and decreased to 25-40 ng/ml in 3 others. The mean tumor volume shrinkage was 25% or greater in 19 patients (86%), 50% or greater in 17 patients (77%), and 75% or greater in 10 patients (45%). Visual abnormalities were reversible after pergolide therapy in all but 1 of 12 patients with initially abnormal formal visual testing. Two out of 4 premenopausal women did not normalize PRL levels and had persistent oligomenorrhea. Testosterone was low in 14 men at presentation and normalized in 3 with pergolide therapy. We conclude that pergolide is a safe, inexpensive, and generally well-tolerated dopamine agonist for the treatment of macroprolactinomas in men and women in whom pregnancy is not of concern. In these specific populations, pergolide may become the first-line therapy for treatment of macroprolactinomas.
Publication Types:
Clinical Trial
PMID: 11788013 [PubMed - indexed for MEDLINE]
I know I saw one where they administered PM and Cab. in each group to determine which was better but I can't find it right now. I want to say they were equal in terms of inhibiting PRL levels but in pre-existing tumors PM almost completely got rid of the tumor. I'll try to find it and if I do I'll email you from my flickenu account.