Research: Benefits of using Cabergoline with Sandostatin LAR

Hot off the press (well, it was published online on May 8th 2009):

Octreotide LAR and Cabergoline association has been shown to be an effective alternative therapy for those acromegalics who still have active acromegaly despite monotherapy with Somatostatin Analogues, mainly for those with lower pretreatment IGF-I concentrations. According to previous studies, the beneficial effects of Cabergoline occur even when pretreatment Prolactin level is normal and/or there is no tumor Growth Hormone/Prolactin co-expression.

See the article here: Neuro Endocrinology Online

A quick bit of background to this… (as far as I understand it!)

The pituitary tumours (adenomas) in acromegaly all pump out growth hormone, but some of these tumours can also pump out other hormones such as Prolactin. If the tumour only pumped out Prolactin, then the tumour would be classed as a “prolactinoma” (and you wouldn’t have acromegaly then either), and the course of treatment for these people would generally be Cabergoline, which is a tablet taken orally. Cabergoline is pretty effective at reducing the mass of prolactinomas to the extent that prolactinomas can disappear altogether. Unfortunately, for people with acromegaly, cabergoline (on its own) doesn’t have such a profound effect as this, but can have beneficial effect is some people.

What this article is saying is that for people who are not getting good control, the addition of Cabergoline can be beneficial even if there is no apparent excess of Prolactin, especially if their original IGF-1 (Growth Factor) is in the lower numbers (but obviously above the normal range).  Previously Cabergoline would only generally be given if the Prolactin was sufficiently elevated.

Obviously don’t go running in to your doctor demanding Cabergoline, he or she still have to balance the benefits and risks of treatments, and have other things to take into account.

Cabergoline & Heart Valve Damage

One particular potential very serious side effect is heart valve damage when taking Cabergoline – but this research was restricted until recently to patients who were treated with Cabergoline for Parkinson’s disease where the dose is much higher. A recent study ( Waki, Clark, Atkin [2008] ) shows that for doses associated with treatment of prolactinomas that heart valve damage is not statistically significant.   Other studies are however less conclusive Kars et al. and suggest cardiac screening.

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