EFFECT OF DIFFERENT DOPAMINERGIC AGENTS IN THE TREATMENT OF ACROMEGALY

Medical treatment of acromegaly with dopamine agonists possesses 2 mai n advantages: the oral administration and the low costs. In this study , we reported on the results of chronic treatments with quinagolide (C V 205-502), cabergoline (CAB) and long-acting depot preparation of bro mocriptine (BRC-LAR) in 34 acromegalics. Patients were divided into th ree groups on the basis of different treatment: CV 205-502 given to 16 patients at the dose of 0.3-0.6 mg/day for 6 months; CAB given to 11 patients at the dose of 1.0-2.0 mg weekly for 6 months; and BRC-LAR in jected into 7 patients at the dose of 100 mg/month for 6-12 months. Ba sal and oral glucose tolerance test-stimulated serum GH levels, basal and TRH-stimulated PRL levels, plasma insulin-like growth factor I(IGF -I) levels, computed tomography scan, and/or magnetic resonance imagin g were assessed before and quarterly during treatments. The chronic ad ministration of CV 205-502, CAB, and BRC-LAR caused a significant decr ease of circulating GH, IGF-I, and PRL levels (P <0.005). Normalizatio n of circulating GH and IGF-I levels was obtained in 7 of 16 (43.8%) p atients treated with CV 205-502. Serum GH response to oral glucose tol erance test (oGTT) significantly improved (P <0.005), and PRL levels w ere significantly suppressed during treatments. No correlation was fou nd between basal and TRH-stimulated PRL levels and GH suppression duri ng different therapies. Immunohistochemical staining revealed 19 GH-po sitive and 10 GH+PRL-positive adenomas. A significant association was found between GH/PRL staining and responsiveness to chronic treatments (chi(2)=7.985, P <0.005). Three patients had significant adenoma shri nkage. Slight nausea and hypotension, which spontaneously disappeared within therapy progression, were referred by 5/16 patients during CV 2 05-502 and 2/7 during BRC-LAR. The results of this study indicate that CAB and BRC-LAR cannot be considered as useful medical approaches for acromegalics, whereas CV 205-502 normalized circulating GH and IGF-I levels in 47.8% of patients.