Cabergoline modulation of alpha-subunits and FSH secretion in a gonadotroph adenoma

J Endocrinol Invest. 2000 Jul-Aug;23(7):463-6. doi: 10.1007/BF03343756.

Abstract

Most non-functioning pituitary adenomas respond poorly to medical therapy. We describe the case of a 62-year-old man who presented with clinical features of an invasive macroadenoma. Baseline hormonal evaluation revealed increased FSH and alpha-subunit (alpha-SU) levels. Transsphenoidal exeresis followed by radiotherapy (RT) was performed. Almost all neoplastic cells were intensely immunoreactive for alpha-SU. On PCR analysis, specific amplification products were observed for somatostatin 2, 3 and 5 receptors as well as for both short and long isoforms of the dopamine D2 receptor. In vitro, alpha-SU and FSH were released into the medium by adenoma cells and increased after TRH stimulation. After surgery, alpha-SU and FSH levels were still elevated. Short-term slow-release lanreotide treatment did not modify either alpha-SU or FSH levels. Cabergoline was started and a fast and long-lasting decrease in alpha-SU and, to a lesser extent, in FSH was observed. The tumor remnant was unmodified on magnetic resonance imaging 3 years after surgery and RT. This case report shows that the in vitro expression of somatostatin receptors may not be directly associated to the in vivo response of alpha-SU and FSH to lanreotide, probably because of a functional uncoupling of the receptors. Cabergoline should be considered as an effective therapy for hormonal, and perhaps proliferative, control of gonadotroph adenoma remnants before the effects of RT are fully effective.

Publication types

  • Case Reports

MeSH terms

  • Adenoma / metabolism*
  • Adenoma / surgery
  • Adenoma / therapy
  • Antineoplastic Agents / therapeutic use*
  • Cabergoline
  • Ergolines / therapeutic use*
  • Follicle Stimulating Hormone / metabolism*
  • Glycoprotein Hormones, alpha Subunit / metabolism*
  • Gonadotropin-Releasing Hormone
  • Humans
  • Male
  • Middle Aged
  • Peptides, Cyclic / therapeutic use
  • Pituitary Neoplasms / metabolism*
  • Pituitary Neoplasms / surgery
  • Pituitary Neoplasms / therapy
  • Radiotherapy
  • Receptors, Dopamine D2 / analysis
  • Receptors, Somatostatin / analysis
  • Somatostatin / analogs & derivatives*
  • Somatostatin / therapeutic use
  • Thyrotropin-Releasing Hormone / pharmacology
  • Tumor Cells, Cultured

Substances

  • Antineoplastic Agents
  • Ergolines
  • Glycoprotein Hormones, alpha Subunit
  • Peptides, Cyclic
  • Receptors, Dopamine D2
  • Receptors, Somatostatin
  • lanreotide
  • Gonadotropin-Releasing Hormone
  • Somatostatin
  • Thyrotropin-Releasing Hormone
  • Follicle Stimulating Hormone
  • Cabergoline