Effect of the Preoperative Use of Dopamine Agonists in the Postoperative Course of Prolactinomas: A Systematic Review

Carija, Robert; Tudor, Mario; Vucina, Diana

doi:10.4158/ep13165.ra

Cited by 11 publications

(4 citation statements)

References 26 publications

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“…Our study confirms the notion that primary surgery may be a more effective method to achieve final remission in microprolactinoma patients with a preoperative PRL level of ≤200 ng/mL. In addition, it is worth noting that the overall cure rate for initial surgical treatment may be higher without preoperative medical treatment due to DA-induced tumour fibrosis [60]. e role of surgical intervention should be re-evaluated in the management of treatment-naive microprolactinoma patients, particularly those with PRL level of ≤200 ng/mL.…”

Section: Discussionsupporting

confidence: 86%

Surgery and Medical Treatment in Microprolactinoma: A Systematic Review and Meta-Analysis

Cai

et al. 2021

International Journal of Endocrinology

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Objective. Dopamine agonists (DAs) are recommended as the first-line treatment for prolactinomas; however, tumour recurrence after drug withdrawal remains a clinical problem. Recent studies have reported high remission rates via surgery in microprolactinomas. The aim of this systematic review and meta-analysis was to compare the clinical result of DA treatment with surgery as initial therapy in patients with treatment-naive microprolactinoma. Methods. A comprehensive literature search for studies and reports regarding microprolactinoma patients treated with DAs and/or surgery published between January 1970 and November 2020 was conducted using four electronic databases (PubMed, Embase, Google Scholar, and the Cochrane Library). Clinical treatment outcome was evaluated by the biochemical remission of serum prolactin level to normal after treatment. The I2 statistic was used to quantify heterogeneity. Pooled data were analysed according to a random effect model. Results. Eighteen studies with 661 patients were included for analysis. The DA treatment group achieved a higher remission rate at ≥12 months follow-up (96% vs. 86%; P = 0.019 ). Surgery showed a higher remission rate than the DA treatment group after the treatment withdrawal (78% vs. 44%; P = 0.003 ). Patients with preoperative prolactin level of ≤200 ng/mL had a higher remission rate than patients with preoperative prolactin level of >200 ng/mL (92% vs. 40%; P = 0.029 ). Conclusion. Surgery showed a high remission rate in treatment-naive microprolactinoma patients after treatment withdrawal and may be an alternative first-line treatment strategy in addition to DAs, particularly in patients with a preoperative prolactin level of ≤200 ng/mL.

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Section: Discussionsupporting

confidence: 86%

Surgery and Medical Treatment in Microprolactinoma: A Systematic Review and Meta-Analysis

Cai

et al. 2021

International Journal of Endocrinology

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“…Higher rates of hormone restoration and visual improvement, and lower incidence of postoperative complications all indicated that effective modern pituitary surgery may be an alternative strategy for the management of prolactinomas ( 21 , 38 ). Besides, evidence showed that surgical cure rates are lower in patients who received DAs treatment prior to operation, possibly due to the drug-induced tumor fibrosis ( 39 , 40 ). From this perspective, we have reasons to consider, between medication and surgery, which is the optimal choice for prolactinomas, particularly for patients with microprolactinomas and low PRL level.…”

Section: Discussionmentioning

confidence: 99%

The Chance of Permanent Cure for Micro- and Macroprolactinomas, Medication or Surgery? A Systematic Review and Meta-Analysis

Liu

et al. 2018

Front. Endocrinol.

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Background: This meta-analysis aims to evaluate the long-term efficacy of medication treatment vs. surgery treatment in patients with prolactinomas.Methods: An electronic literature search was performed using MEDLINE, EMBASE and Web of Science databases for studies dated before July in 2018. Patients with prolactinomas received primary dopamine agonists (DAs) treatment or primary surgical interventions were included in this study. A systematic review and meta-analysis were performed in pertinent studies meeting eligible criteria. The clinical outcome was measured by the long-term remission rate of prolactin (PRL) in each cohort. The pooled data was analyzed according to a random effect model.Results: Thirteen publications with total 809 patients were included in the final meta-analysis. In the overall patients with prolactinomas, long-term remission rate was achieved in 88% patients treated with surgeries and in 52% patients treated with DAs (P = 0.001). The long-term remission rates in surgery cohort were also significantly higher than medication cohort in both microprolactinomas and macroprolactinomas (91 vs. 60%, P = 0.002; 77 vs. 43%, P = 0.003).Conclusions: Patients with prolactinomas, especially microprolactinomas, can consider transsphenoidal surgery as an alternative first-line treatment strategy. After receiving primary surgical intervention, administration of DAs should be considered based on the postoperative PRL level to achieve the best long-term remission rate.

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“…This has been highlighted as a factor in non-remission in some surgical studies [70,71]. This effect is considerably less frequent in patients treated with cabergoline [70,72], and other studies have not found a negative impact of pre-surgical DA use on post-operative remission [73,74]. A 2021 meta-analysis, however, did show a significant negative effect of DA pre-treatment [75].…”

Section: Effect On Future Pituitary Surgerymentioning

confidence: 98%

Treatment of Prolactinoma

Inder

Jang

2022

Medicina

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Prolactinomas are the commonest form of pituitary neuroendocrine tumor (PitNET), representing approximately half of such tumors. Dopamine agonists (DAs) have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line. The aim of this review is to examine the historical and modern management of prolactinomas, including medical therapy with DAs, transsphenoidal surgery, and multimodality therapy for the treatment of aggressive prolactinomas and metastatic PitNETs, with an emphasis on the efficacy, safety, and future directions of current therapeutic modalities. DAs have been the mainstay of prolactinoma management since the 1970s, initially with bromocriptine and more recently with cabergoline. Cabergoline normalizes prolactin in up to 85% of patients and causes tumor shrinkage in up to 80%. Primary surgical resection of microprolactinomas and enclosed macroprolactinomas performed by experienced pituitary neurosurgeons have similar remission rates to cabergoline. Aggressive prolactinomas and metastatic PitNETS should receive multimodality therapy including high dose cabergoline, surgery, radiation therapy (preferably using stereotactic radiosurgery where suitable), and temozolomide. DAs remain a reliable mode of therapy for most prolactinomas but results from transsphenoidal surgery in expert hands have improved considerably over the last one to two decades. Surgery should be strongly considered as primary therapy, particularly in the setting of microprolactinomas, non-invasive macroprolactinomas, or prior to attempting pregnancy, and has an important role in the management of DA resistant and aggressive prolactinomas.

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Effect of the Preoperative Use of Dopamine Agonists in the Postoperative Course of Prolactinomas: A Systematic Review

Cited by 11 publications

References 26 publications

Surgery and Medical Treatment in Microprolactinoma: A Systematic Review and Meta-Analysis

Surgery and Medical Treatment in Microprolactinoma: A Systematic Review and Meta-Analysis

The Chance of Permanent Cure for Micro- and Macroprolactinomas, Medication or Surgery? A Systematic Review and Meta-Analysis

Treatment of Prolactinoma

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