Elevated levels of prolactin inhibit the pulsatile secretion of GnRH, and that can cause severe oligospemia in men, thus presenting with hypogonadism and infertility. In such situations, dopamine agonists are indicated for the treatment of infertility and the pituitary tumor. Both bromocriptine and cabergoline can be used. Nevertheless, cabergoline is more efficient than bromocriptine in cutting prolactin production (Webster J et al 1992), and has been shown to normalize prolactin levels in 70% of bromocriptine-resistant patients Verhelst J et al 1999). Consequently, cabergoline (0.125-1.0 mg twice weekly) is the favored option, as it has the utmost efficacy in regulating prolactin levels and attenuating prolactin-secreting tumors
For further reading see: http://www.amepc.org/tau/article/view/3512/4358
Webster J, Piscitelli G, Polli A, et al. Dose-dependent suppression of serum prolactin by cabergoline in hyperprolactinaemia: a placebo controlled, double blind, multicentre study. European Multicentre Cabergoline Dose-finding Study Group. Clin Endocrinol (Oxf) 1992;37:534-41.
Verhelst J, Abs R, Maiter D, et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 1999;84:2518-22.
It is well known that a normal serum prolactin level is not reliably exclusive of a truly increased prolactin activity, given the variable bioforms of the hormone. Moreover, cabergoline has been used in women with idiopathic infertility. It provides a more effective and better tolerated treatment compared with bromocriptine and may offer effective therapies for bromocriptine-resistant or intolerant patients.
cabergoline has been used in hyperprolactinaemia in females and its usage as an alternative in regulating prolactin in prolactin-secreting tumours is controversal.
Dear Ahmad
Thank you for the answer , but do you have any article regarding the use of cabergoline in women with unexplained infertility, I never heard about that?
Thx.!
Dopamine agonists have successfully been used to treat male infertility due to hyperprolactinemia, but have shown little promise as an empirical therapy for idiopathic male infertility (Hamada AJ, Montgomery B, Agarwal A. Male infertility: a critical review of pharmacologic management. Expert Opin Pharmacother. 2012 Dec;13(17):2511-31).
REFERENCES:
2- Liu PY, Handelsman DJ. The present and future state of hormonal treatment for male infertility. Hum Reprod Update 2003;Jan-Feb9(1):9-23.
3- De Rosa M, Zarrilli S, Di Sarno A, et al. Hyperprolactinemia in men: clinical and biochemical features and response to treatment. Endocrine 2003;Feb-Mar20(1-2):75-82.
In females clinical presentation like anovulation, amenorrhea, galactorrhea is earlier even in small microadenoma but in male prolactinoma requires large in size to cause clinical symptoms due to pressure effects & loss of libido and oligospermia in11% of males due to secondary hypogonadism. Hence dopamine agonists can is useful in female as these can regress the tumour but since the tumour is large in male medical followed by surgical treatment may be necessary.
REFERENCES:
Pratiba singh et al.Hyperprolactinemia: An often missing cause of male infertility. Journal of Human Reproductive sciences- vol 4,issue 2, may-aug-2011:102-103.
Dhole GR. et al - EUA Guidelines on male infertility- Eur Urol 2005;48:703-11
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