Pituitary · 2026
Cabergoline for non-functioning pituitary adenomas: an update on an old clinical controversy.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Tatar Omer Denizhan, Karakose Melia
Аннотация
PURPOSE: Cabergoline has been used off-label for non-functioning pituitary adenomas (NFPAs) for decades, yet its place in management remains controversial. We reappraised the evidence, emphasizing studies from the last 3-5 years and how contemporary natural-history data influence interpretation of radiological outcomes.
METHODS: We conducted a focused PubMed/MEDLINE search from database inception through 27 September 2026, prioritizing comparative studies, recent cohorts, systematic reviews, natural-history studies, translational research, and clinically relevant safety data. Evidence was synthesized narratively.
RESULTS: Earlier studies suggested radiological activity, but the only randomized open-label trial showed primarily a radiological signal, with less growth and more shrinkage, rather than established patient-centered clinical benefit. A 2022 meta-analysis estimated at least 20% shrinkage in 19% and an outcome classified as prevention of progression in 50%. Recent data remain inconsistent: a 2022 multicenter comparison found no clear radiological advantage over observation, a 2024 surgery-naive cohort reported shrinkage/stability/growth in 20%/48%/32%, and 2026 real-world and radiotherapy cohorts have not resolved comparative efficacy. Contemporary natural-history studies show that untreated NFPAs may remain stable, regress, or grow unpredictably. No validated molecular or pathological predictor of cabergoline response has emerged.
CONCLUSION: Recent evidence adds context but does not resolve this long-standing controversy or support routine cabergoline therapy for NFPAs. Cabergoline remains off-label and has no established routine role; it should not displace established surveillance, neurosurgical, or radiotherapy strategies. Prospective controlled studies using standardized volumetric imaging and patient-centered outcomes are needed.
METHODS: We conducted a focused PubMed/MEDLINE search from database inception through 27 September 2026, prioritizing comparative studies, recent cohorts, systematic reviews, natural-history studies, translational research, and clinically relevant safety data. Evidence was synthesized narratively.
RESULTS: Earlier studies suggested radiological activity, but the only randomized open-label trial showed primarily a radiological signal, with less growth and more shrinkage, rather than established patient-centered clinical benefit. A 2022 meta-analysis estimated at least 20% shrinkage in 19% and an outcome classified as prevention of progression in 50%. Recent data remain inconsistent: a 2022 multicenter comparison found no clear radiological advantage over observation, a 2024 surgery-naive cohort reported shrinkage/stability/growth in 20%/48%/32%, and 2026 real-world and radiotherapy cohorts have not resolved comparative efficacy. Contemporary natural-history studies show that untreated NFPAs may remain stable, regress, or grow unpredictably. No validated molecular or pathological predictor of cabergoline response has emerged.
CONCLUSION: Recent evidence adds context but does not resolve this long-standing controversy or support routine cabergoline therapy for NFPAs. Cabergoline remains off-label and has no established routine role; it should not displace established surveillance, neurosurgical, or radiotherapy strategies. Prospective controlled studies using standardized volumetric imaging and patient-centered outcomes are needed.