Effects of Pituitary Surgery and High-Dose Cabergoline Therapy on Metabolic Profile in Patients With Prolactinoma Resistant to Conventional Cabergoline Treatment.

Abstract

Objective:

Control of prolactin excess is associated with the improvement in gluco-insulinemic and lipid profile. The current study aimed at investigating the effects of pituitary surgery and medical therapy with high dose cabergoline (≥2mg/week) on metabolic profile in patients with prolactinoma resistant to cabergoline conventional doses (<2mg/week).

Design:

Thirty-four patients (22 men, 12 women, aged 33.9 ± 12.5 years) with prolactinoma (4 microadenomas and 30 macroadenomas) were included in the present study. Among them 17 (50%) received pituitary surgery (PS, Group1) and 17 (50%) medical therapy with high dose cabergoline (Group 2).

Methods:

In the whole patient cohort, anthropometric (weight, BMI) and biochemical (fasting glucose and insulin, triglycerides, total, HDL and LDL-cholesterol, HOMA-IR, HOMA-β and ISI0) parameters were evaluated before and within 12 months after treatment.

Results:

In Group 1, prolactin (p=0.002), total cholesterol (p=0.012), and triglycerides (p=0.030) significantly decreased after pituitary surgery compared to the baseline. Prolactin significantly correlated with fasting glucose (r=0.056, p=0.025). In Group 2, fasting insulin (p=0.033), HOMA-β (p=0.011) and ISI0 (p=0.011) significantly improved compared to baseline. Postoperative cabergoline dose significantly correlated with Δfasting glucose (r=-0.556, p=0.039) and ΔLDL cholesterol (r=- 0.521, p=0.046), and was the best predictor of ΔLDL cholesterol (r2 = 0.59, p=0.002) in Group 1.

Conclusions:

The rapid decrease in PRL levels induced by PS might improve lipid metabolism, whereas HD-CAB might exert a beneficial impact on both insulin secretion and peripheral sensitivity, thus inducing a global metabolic improvement.

• Authors: Rosa Pirchio, Renata S Auriemma, Domenico Solari, Mauro Arnesi, Claudia Pivonello, Mariarosaria Negri, Cristina de Angelis, Luigi M Cavallo, Paolo Cappabianca, Annamaria Colao, Rosario Pivonello
• Journal: Frontiers in endocrinology (Front Endocrinol (Lausanne)) Vol. 12 Pg. 769744 ( 2021) ISSN: 1664-2392 [Print] Switzerland
• PMID: 34917030 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Pirchio, Auriemma, Solari, Arnesi, Pivonello, Negri, de Angelis, Cavallo, Cappabianca, Colao and Pivonello.

Chemical References

• Blood Glucose
• Dopamine Agonists
• Insulin
• Cabergoline

Topics

• Adult
• Blood Glucose
• Cabergoline (therapeutic use)
• Combined Modality Therapy
• Dopamine Agonists (therapeutic use)
• Female
• Humans
• Insulin (blood)
• Insulin Resistance
• Male
• Metabolome (drug effects)
• Middle Aged
• Pituitary Gland (surgery)
• Pituitary Neoplasms (blood, drug therapy, surgery)
• Prolactinoma (blood, drug therapy, surgery)
• Treatment Outcome
• Young Adult