Objective
To estimate the proportion of patients with persistent normoprolactinaemia following dopamine agonist (DA) withdrawal and to identify predictors of successful withdrawal in patients with hyperprolactinaemia.
Design, patients, and measurements
A systematic review of observational eligible studies were identified by searching PubMed and Embase. The primary outcome was the proportion of patients with normoprolactinaemia after cessation of DA treatment. Secondary outcome included the proportion of patients with normoprolactinaemia after DA withdrawal using individual patient data. Risk of bias was assessed by using Newcastle‐Ottawa Scale. Pooled proportions were estimated using a random effects model in case I2 ≤ 75% or by reporting range of effects if I2 > 75%.
Results
Thirty‐two observational studies enroling 1563 patients were included. The proportion of patients with persistent normoprolactinaemia ranged from 0% to 75% (I2 = 84%). Heterogeneity was partly explained by age with more successful withdrawal in patients of higher age. Individual patient data analyses suggested that the proportion of patients with persistent normoprolactinaemia 6 months after DA withdrawal with a low maintenance dose and full regression of the prolactinoma was 87.7% (95% confidence interval [CI] = 60.7–97.1; I2 = 0%) and 58.4% (95% CI = 23.8–86.3; I2 = 75%) for microadenomas and macroadenomas, respectively.
Conclusions
The proportion of patients with persistent normoprolactinaemia following DA withdrawal treatment varied greatly, partly explained by the mean age of participants of the individual studies. Individual patient data analysis suggested that successful withdrawal was likely in patients with full regression of prolactinomas using a low maintenance dose before cessation.
The purpose of this study was to determine possible cut-off levels of basal
DHEA-S percentile rank in the differential diagnosis of patients with
Cushing’s syndrome (CS) with ACTH levels in the gray zone and normal
DHEA-S levels. In this retrospective study including 623 pathologically confirmed CS, the
DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within
reference interval. The patients were classified as group 1 (n=265
Cushing’s disease; CD), group 2 (n=104 adrenal CS) and group 3
(n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate
the optimal cut-off level of DHEA-S percentile rank in the reference interval in
the differential diagnosis of CS, and the effectiveness of this cut-off level in
the identification of the accurate etiology of CS was assessed in patients who
were in gray zone according to their ACTH levels. The DHEA-S percentile rank in the reference interval were significantly
lower in group 2 compared to the other two groups (p<0.001), while group
1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile
rank in the reference interval providing differential diagnosis between group 1
and group 2 was calculated as 19.5th percentile (80.8% sensitivity,
81.5% specificity) and the level demonstrated the accurate etiology in
100% of CD and 76% of adrenal CS patients who were in the gray
zone. This study showed that the cut-off value of DHEA-S level less than
20% of the reference interval could be used for differential diagnosis
of CD and adrenal CS with high sensitivity and specificity, and it should be
taken into the initial evaluation.
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