High dose dopamine agonist treatment and combination of dopamine agonists

2005 ◽  
Vol 32 (06) ◽  
Author(s):  
P Odin ◽  
C Oehlwein ◽  
A Storch ◽  
U Polzer ◽  
G Werner ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
High Dose

Apoplexy of microprolactinomas during pregnancy

2021 ◽  
Author(s):  
Emmanuelle Kuhn ◽  
Alexandra A Weinreich ◽  
N R Biermasz ◽  
Jens Otto L. Jorgensen ◽  
Philippe Chanson
Keyword(s):  
Literature Review ◽  
Dopamine Agonist ◽  
Systematic Literature Review ◽  
Dopamine Agonists ◽  
Pituitary Apoplexy ◽  
Clinical Event ◽  
Female Patients ◽  
Pregnancy Diagnosis ◽  
Assessment And Treatment ◽  
Ophthalmological Assessment

Abstract Context: Prolactinomas frequently cause amenorrhoea, galactorrhoea and infertility and require dopamine agonist (DA) treatment to normalize prolactin levels and hence restore ovulation. The vast majority of female patients harbour microprolactinomas in whom DA treatment is usually discontinued at the time of pregnancy diagnosis, and surveillance is generally limited as symptomatic growth is considered very rare. Case Descriptions: We report five cases of women harbouring a microprolactinoma in whom symptomatic pituitary apoplexy occurred during pregnancy. Only one necessitated surgery during pregnancy, while the others were treated conservatively by reintroducing DAs in three. A systematic literature review found reports of four additional cases among 20 cases of prolactinomas (both macro- and microprolactinomas) complicated by apoplexy during pregnancy. Conclusion: During pregnancy, pituitary apoplexy may occur in pre-existing microprolactinomas, causing tumour enlargement and headache, which may be self-limiting but may require intervention by re-initation of dopamine agonists or surgery. Our literature review confirms that this clinical event is rare; nevertheless, physicians managing pregnant patients with microprolactinomas must be aware that symptomatic pituitary apoplexy may incidentally occur in all trimesters of pregnancy and require prompt radiological, endocrine and ophthalmological assessment and treatment.

scholarly journals Effects of combination therapy: somatostatin analogues and dopamine agonists on GH and IGF1 levels in acromegaly

2015 ◽  
Vol 88 (3) ◽  
pp. 310-313 ◽  
Author(s):  
Ana Valea ◽  
Cristina Ghervan ◽  
Mara Carsote ◽  
Andra Morar ◽  
Iulia Iacob ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Combination Therapy ◽  
Dopamine Agonist ◽  
Normal Level ◽  
Dopamine Agonists ◽  
Somatostatin Analogues ◽  
Somatostatin Analogue ◽  
Endocrine Disorder ◽  
Excessive Secretion

 Background and aims. Acromegaly is a complex endocrine disorder caused by excessive secretion of GH, secondary to a GH secreting pituitary adenoma or a mixed pituitary adenoma secreting GH and PRL.Methods. The aim of this study was to evaluate the effects of combination therapy: dopamine agonist and somatostatin analogue on GH and IGF1 levels in a group of 30 patients with acromegaly. Cabergoline in a dose of 2 mg/week and 4 mg/week respectively was associated with Sandostatin LAR in a dose of 20 mg/month and 30 mg/months respectively. Eight patients were treated with Lanreotide 30 mg/week and Cabergoline 2 mg/week and 3 patients were treated with Bromocriptine 10 mg/day and Sandostatin LAR 30 mg/month.Results. Combination therapy: Cabergoline and Sandostatin achieved normal levels of IGF1  in 32% of the patients, better results being obtained after 12 months of treatment in the group treated with 4 mg Cabergoline/week. In 37% of cases the levels of IGF1 decreased by 50% after 12 months of treatment. In the group treated with Cabergoline and Somatuline a normal level of IGF1 was achieved in 25% of patients after 12 months of treatment. The outcome for the group treated with Sandostatin and Bromocriptine was similar to that obtained under Cabergoline 2 mg/week. There was no significant correlation between the level of GH and the type or dose of dopamine agonist used.Conclusions. In conclusion, combination therapy consisting of dopamine agonist and somatostatin analogue achieves a significant reduction of IGF1 levels in patients with mixed adenomas secreting GH and PRL. A decrease in IGF1 levels is directly correlated with the dose of Cabergoline used. 

scholarly journals Dopamine Gene Profiling to Predict Impulse Control and Effects of Dopamine Agonist Ropinirole

2016 ◽  
Vol 28 (7) ◽  
pp. 909-919 ◽  
Author(s):  
Hayley J. MacDonald ◽  
Cathy M. Stinear ◽  
April Ren ◽  
James P. Coxon ◽  
Justin Kao ◽  
...  
Keyword(s):  
Decision Making ◽  
Dopamine Agonist ◽  
Risk Score ◽  
Response Inhibition ◽  
Genetic Risk ◽  
Impulse Control ◽  
Dopamine Agonists ◽  
Genetic Risk Score ◽  
Stop Signal ◽  
Controlled Study

Dopamine agonists can impair inhibitory control and cause impulse control disorders for those with Parkinson disease (PD), although mechanistically this is not well understood. In this study, we hypothesized that the extent of such drug effects on impulse control is related to specific dopamine gene polymorphisms. This double-blind, placebo-controlled study aimed to examine the effect of single doses of 0.5 and 1.0 mg of the dopamine agonist ropinirole on impulse control in healthy adults of typical age for PD onset. Impulse control was measured by stop signal RT on a response inhibition task and by an index of impulsive decision-making on the Balloon Analogue Risk Task. A dopamine genetic risk score quantified basal dopamine neurotransmission from the influence of five genes: catechol-O-methyltransferase, dopamine transporter, and those encoding receptors D1, D2, and D3. With placebo, impulse control was better for the high versus low genetic risk score groups. Ropinirole modulated impulse control in a manner dependent on genetic risk score. For the lower score group, both doses improved response inhibition (decreased stop signal RT) whereas the lower dose reduced impulsiveness in decision-making. Conversely, the higher score group showed a trend for worsened response inhibition on the lower dose whereas both doses increased impulsiveness in decision-making. The implications of the present findings are that genotyping can be used to predict impulse control and whether it will improve or worsen with the administration of dopamine agonists.

scholarly journals Case Report: Temozolomide Treatment of Refractory Prolactinoma Resistant to Dopamine Agonists

2021 ◽  
Vol 12 ◽  
Author(s):  
Hao Tang ◽  
Yijun Cheng ◽  
Jinyan Huang ◽  
Jianfeng Li ◽  
Benyan Zhang ◽  
...  
Keyword(s):  
Complete Remission ◽  
Genome Sequencing ◽  
Copy Number ◽  
Dopamine Agonists ◽  
Tumor Volume ◽  
Gene Mutations ◽  
High Sensitivity ◽  
High Dose ◽  
Ki 67 ◽  
Continuous Increase

Therapeutic agents for refractory prolactinomas that are resistant to dopamine agonists (DAs) are troublesome, and surgery often only removes a large part of the tumor without complete remission. Among the various second-line treatment regimens, the treatment effect of the alkylating agent temozolomide (TMZ) is only effective for approximately half of patients; however, complete remission is rare. Here we report a patient with prolactinoma who was resistant to high-dose cabergoline (CAB) treatment, demonstrating a continuous increase in both the tumor volume and the prolactin (PRL) level. Given that this case is a refractory prolactinoma, the patient underwent two transsphenoidal approach (TSA) surgeries. The pathological analysis indicated that the Ki-67 index increased significantly from 3% to 30%, and the expression levels of DRD2 and MGMT were low. Finally, TMZ treatment was recommended. A total of six cycles of TMZ standard chemotherapy shrank the tumor volume and the tumor disappeared completely. During the 6-month follow-up period, the tumor did not relapse again, and the PRL level was also normal. RNA sequencing and DNA whole genome sequencing were performed on this prolactinoma specimen, revealing 16 possible gene mutations, including a missense mutation of the PABPC1 gene. Additionally, the copy number variation analysis results showed that several chromosomes had copy number gains compared to the matched peripheral blood sample. In this case, low expression of DRD2 and high proliferation led to resistance to CAB, whereas low MGMT expression contributed to sensitivity to TMZ treatment. The results of genome sequencing still need further investigation at the molecular level to explain the tumor aggressiveness and high sensitivity to TMZ.

Meta-analysis and review of dopamine agonists in acute episodes of mood disorder: Efficacy and safety

2018 ◽  
Vol 32 (4) ◽  
pp. 385-396 ◽  
Author(s):  
Bruno Romeo ◽  
Lisa Blecha ◽  
Katia Locatelli ◽  
Amine Benyamina ◽  
Catherine Martelli
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Mood Disorder ◽  
Dopamine Agonists ◽  
Low Dose ◽  
Meta Analysis ◽  
High Dose ◽  
Efficacy And Safety ◽  
Major Depressive ◽  
Remission Rates

The objective of this meta-analysis is to assess the efficacy and safety of partial and complete dopamine agonists in the treatment of acute mood disorder episodes. Randomized, double-blind and placebo-controlled trials of dopamine agonists in the treatment of acute mood disorder episodes were identified in the MEDLINE and PsycINFO databases and included in the meta-analysis. In monotherapy of mania, improved remission rates were found for cariprazine (odds ratio (OR): 2.08, P < 0.01) and for high-dose aripiprazole (OR: 3.00; P = 0.05), but not for low-dose aripiprazole. In bipolar depression, no improvement of remission and response rates was found for aripiprazole in monotherapy, whereas improved response rate (OR: 10.27, P < 0.01) was found for pramipexole only as an add-on to another mood stabilizer. In major depressive disorder, relatively similar improvements of remission rates were found for high-dose (OR: 1.96, p < 0.01) and low-dose aripiprazole (OR: 1.68, P = 0.01), as well as brexpiprazole (OR: 1.52, P = 0.05) as an add-on to antidepressant medication. Our meta-analysis shows that partial dopamine agonists at high doses are effective in treating acute mania. In major depressive disorder, which is resistant to classical antidepressants, low doses of partial dopamine agonists as adjunct therapy may represent a relatively safe and effective alternative.

scholarly journals Homocysteine Levels in Parkinson’s Disease: Is Entacapone Effective?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Bilge Kocer ◽  
Hayat Guven ◽  
Selim Selcuk Comoglu
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Folic Acid ◽  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
Rating Scale ◽  
Comt Inhibitors ◽  
Group Iii ◽  
Group I ◽  
Significant Difference

Plasma homocysteine (Hcy) levels may increase in levodopa-treated patients with Parkinson’s disease (PD) as a consequence of levodopa methylation via catechol-O-methyltransferase (COMT). Results from previous studies that assessed the effect of COMT inhibitors on levodopa-induced hyperhomocysteinemia are conflicting. We aimed to evaluate the effects of levodopa and entacapone on plasma Hcy levels. A hundred PD patients were enrolled to the study and divided into three treatment groups (group I: levodopa and/or dopamine agonists; group II: levodopa, entacapone, and/or a dopamine agonist; and group III: dopamine agonist alone). We measured the serum B12, folic acid, and Hcy levels in all patients. There were no statistically significant differences between groups in terms of modified Hoehn and Yahr stages, Unified Parkinson’s Disease Rating Scale II/III, Standardized Mini-Mental Test scores, and serum vitamin B12 and folic acid levels. Plasma median Hcy levels were found above the normal laboratory values in groups I and II, but they were normal in group III. However, there was no statistically significant difference in plasma Hcy levels between groups. Our results showed that levodopa treatment may cause a slight increase in the Hcy levels in PD compared with dopamine agonists and that COMT inhibitors may not have a significant effect on preventing hyperhomocysteinemia.

scholarly journals Dopamine Agonists and the Suppression of Impulsive Motor Actions in Parkinson Disease

2012 ◽  
Vol 24 (8) ◽  
pp. 1709-1724 ◽  
Author(s):  
Scott A. Wylie ◽  
Daniel O. Claassen ◽  
Hilde M. Huizenga ◽  
Kerilyn D. Schewel ◽  
K. Richard Ridderinkhof ◽  
...  
Keyword(s):  
Motor Control ◽  
Cognitive Control ◽  
Parkinson Disease ◽  
Dopamine Agonist ◽  
Behavioral Problems ◽  
Dopamine Agonists ◽  
Conflict Task ◽  
Compulsive Behaviors ◽  
Impulsive Response ◽  
Motor Actions

The suppression of spontaneous motor impulses is an essential facet of cognitive control that is linked to frontal-BG circuitry. BG dysfunction caused by Parkinson disease (PD) disrupts the proficiency of action suppression, but how pharmacotherapy for PD impacts impulsive motor control is poorly understood. Dopamine agonists improve motor symptoms of PD but can also provoke impulsive–compulsive behaviors (ICB). We investigated whether dopamine agonist medication has a beneficial or detrimental effect on impulsive action control in 38 PD patients, half of whom had current ICB. Participants performed the Simon conflict task, which measures susceptibility to acting on spontaneous action impulses as well as the proficiency of suppressing these impulses. Compared with an off-agonist state, patients on their agonists were no more susceptible to reacting impulsively but were less proficient at suppressing the interference from the activation of impulsive actions. Importantly, agonist effects depended on baseline performance in the off-agonist state; more proficient suppressors off agonist experienced a reduction in suppression on agonist, whereas less-proficient suppressors off agonist showed improved suppression on agonist. Patients with active ICB were actually less susceptible to making fast, impulsive response errors than patients without ICB, suggesting that behavioral problems in this subset of patients may be less related to impulsivity in motor control. Our findings provide further evidence that dopamine agonist medication impacts specific cognitive control processes and that the direction of its effects depends on individual differences in performance off medication.

Dopamine agonist–resistant prolactinomas

2011 ◽  
Vol 114 (5) ◽  
pp. 1369-1379 ◽  
Author(s):  
Michael C. Oh ◽  
Manish K. Aghi
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
Treatment Options ◽  
Resistance Mechanisms ◽  
Treatment Regimens ◽  
Dopamine Agonist Therapy ◽  
Male Patients ◽  
Medical Therapies ◽  
Line Of Therapy ◽  
Estrogen Receptor Antagonists

The authors' object in this paper was to review the definition, epidemiology, biology, resistance mechanisms, and treatment options for dopamine agonist–resistant prolactinomas (DARPs). Prolactinomas are relatively unique among primary brain tumors in that medical treatment alone using dopamine agonists carries a high probability of disease control or even radiographic and endocrine remission, and thus has replaced surgery as the first line of therapy. Unfortunately, slightly less than 10% of patients with prolactinomas do not experience normalization of their prolactin levels in response to dopamine agonists, and harbor tumors that are resistant to dopamine agonist therapy. A literature review underscores that in male patients these DARPs are more likely to be invasive macroadenomas than dopamine agonist–responsive prolactinomas and that they are also more angiogenic, more proliferative, and more likely to exhibit cellular atypia. Estrogen receptor antagonists and temozolomide are the most commonly applied medical therapies in cases in which resection and radiosurgery have not induced remission of the hyperprolactinemia. Dopamine agonist–resistant prolactinomas exhibit aggressive behavior and tend to be large, invasive, hyperangiogenic tumors with high mitotic indices, which makes their management via surgery, radiosurgery, or alternative medical therapies challenging, thus underscoring the need for novel medical therapies or treatment regimens that target these lesions.

526 Characteristics of Augmented RLS Patients on Dopamine Agonists at a Tertiary Referral Center: Where Do We Go From Here?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A207-A207
Author(s):  
Jonathan Yeung Laiwah ◽  
John Winkelman
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
Brain Research ◽  
Transferrin Saturation ◽  
Agonist Therapy ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Dopamine Agonist Therapy ◽  
Obstructive Sleep

Abstract Introduction Augmentation is a management dilemma in RLS patients on dopaminergic therapy. Understanding the clinical characteristics of such patients may assist in better management strategies. Methods Consecutive new consultations for RLS from 4/2016-6/2020 were identified from a single tertiary referral center in Boston, USA. Patients were included in this analysis if they had augmentation and current treatment with a dopamine agonist. Clinical information from initial consultation was collected. RLS severity at time of consultation was determined retrospectively with a modified IRLSSG severity score (0–12), assessing RLS symptom frequency (0–4), duration (0–4), and severity (0–4). Results Out of 209 referrals with RLS, 105 patients had augmentation, of whom 88 were on dopamine agonists at initial evaluation. Average age was 67 years (SD 11 years, range 39–88); 62 were female (59%). Mean duration of RLS symptoms was 27 years (SD 20), and 91% had symptoms &gt; 10 years. Mean duration of dopamine agonist therapy was 11 years; 72% had previously been treated with pramipexole, 65% with ropinirole, 73% with rotigotine, and 16% with levodopa; 72% of patients had been treated with alpha-2-delta ligands, and 28% with opioids. Common comorbidities included obstructive sleep apnea (47%), obesity (49%), and depression (44%). Serotonergic medications were currently used by 25%. Of the 88 augmented patients on dopamine agonist therapy, 97% had earlier onset of symptoms and 33% had symptoms in both morning and afternoon; 53% reported anatomical extension. The mean modified IRLSSG score was 8.4 (SD 3.2). 66% of patients had either ferritin &lt;75 mcg/L or transferrin saturation &lt;20%. At the time of initial assessment, 49% were on pramipexole, 47% on rotigotine, 5% on rotigotine and 7% on levodopa: mean daily dopamine agonist dose was 1.23 mg (SD 1.20) of pramipexole equivalent. 37% were on alpha-2-delta ligands: mean daily dose 1014 mg (SD 830, median 700 mg) of gabapentin equivalent. Conclusion Higher than FDA-recommended dopamine agonist dosing and high prevalence of iron deficiency in patients with augmented RLS represent a treatment gap in the care of RLS patients in the community. Controlled studies of guideline-based therapy are indicated to determine optimal management of augmented RLS. Support (if any) Baszucki Brain Research Fund

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