Long-Term Remission Following Withdrawal of Dopamine Agonist Therapy in Subjects With Microprolactinomas

Abstract

The Fibroid Registry for Outcomes Data (FIBROID) was founded in 1999 to serve as a prospective multicenter database of women undergoing uterine embolization for leiomyomata. This paper presents an analysis of the short-term outcomes of patients enrolled at 72 participating sites. Of a total 3005 patients, 2729 had a 30-day follow-up interview, which provided information on any further medical care, adverse events, time to return to work, and time to return to normal activities. The Registry defined an adverse event as an unexpected problem that required an unanticipated clinic visit or unanticipated therapy.Seventy-four percent of all patients received preprocedure antibiotics and one fourth was also given antibiotics postprocedure. Uterine embolizations were generally carried out under intravenous conscious sedation and supplemented with narcotics, two thirds of which were patient-controlled. In one participating center, regional analgesia was used in 12% of cases. Overall, 5% of patients had postprocedure deep vein thrombosis (DVT) prophylaxis with automated intermittent compression boots.Seventy-four percent of procedures were technically successful. Technical failures occurred when only one uterine artery could be identified for embolization or when bilateral uterine artery catheterization was unsuccessful.The average hospital stay was 1.68 days. During hospitalization, 90 patients experienced 94 adverse events, of which 20 were major. Eleven of these prolonged the hospital stay. Pain and nausea were the most common conditions, but one patient had a femoral nerve injury, which resulted in permanent leg pain. Other problems included drug reaction, urinary retention, and contrast reaction. Of 74 minor complications, groin hematomas were the most common (n ϭ 22). Other minor complications included less severe nausea, pain, vessel injury, drug reaction, urinary retention, and contrast reaction, as well as device-related problems and nontarget embolization. Patients generally resumed normal activities after 2 weeks.Major and minor adverse events were combined for univariate analysis. Possible predictors for perioperative complications, including patient demographic variables, medical history variables, presenting signs and symptoms, medications used, procedure-related variables, and site-related variables, were included. Only length of procedure, site status (ie, core registry sites vs participating sites), and size of leiomyomata were found to have predictive value for operative complications (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.005-1.019; OR, 0.334; 95% CI, 0.15-0.76; OR, 1.0173; 95% CI, 1.0131-0138; respectively). After multivariate analysis, site status was no longer predictive of perioperative adverse advents.By the 1-month postprocedure evaluation, 710 patients had reported adverse events. Major complications (n ϭ 111; 4%) were persistent bleeding in 7 patients, infection or possible infection in 17, new hot flashes in 2, thromboembolism GYNECOLOGY Volume 60, Number 11 OBSTETRICAL AND GYN...

Predictors of remission of hyperprolactinaemia after long‐term withdrawal of cabergoline therapy

“…Withdrawal from CAB treatment, which is known to be superior to bromocriptine, 2,4,7,9,12,13 was followed by remission of hyperprolactinaemia in 22 -31% of patients. 8,10,29,31 More recently, we reported an estimated hyperprolactinaemia recurrence rate of 24% in NTH, 32·6% in patients with micro-, and 43·3% in those with macroprolactinomas in carefully selected patients in 2-5 years after CAB withdrawal. 19 Of clinical relevance, none of the patients experiencing recurrent hyperprolactinaemia showed tumour re-growth and only a minority noticed reappearance of symptoms of gonadal dysfunction.…”

“…Previous studies investigating the results of withdrawal from bromocriptine treatment, mainly in patients with microprolactinomas or NTH, have reported remission rates ranging from very disappointing (< 10%) [20][21][22][23] to moderate (20 -44%). [24][25][26][27][28][29] The only study of exclusively patients with macroprolactinomas showed a remission rate of 8%. 30 High recurrence rates of hyperprolactinaemia were reported after treatment withdrawal of pergolide or quinagolide; 21,31 however, only a few patients have been studied with these two latter drugs.…”

Recurrence of hyperprolactinaemia following discontinuation of dopamine agonist therapy in patients with prolactinoma occurs commonly especially in macroprolactinoma

“…11 Other studies have shown comparable recurrence rates to those that we demonstrate in our data: Cannavo and colleagues reported an 81AE5% recurrence rate at 1 year following DA withdrawal in unselected patients (n = 27) with both macroprolactinomas and microprolactinomas 18 ; Biswas and colleagues reported on 67 patients with microprolactinoma with a recurrence rate of 68AE7%. 19 Previously, in a retrospective study by Passos and colleagues on 131 patients with prolactinoma (62 with microprolactinoma and 69 with macroprolactinoma) who had achieved normalization of serum prolactin with bromocriptine, only 25AE8% of microprolactinomas and 15AE9% of macroprolactinomas persisted with normoprolactinaemia during a median of 44 months following bromocriptine withdrawal. 20 The five published studies on recurrence of hyperprolactinaemia following cabergoline withdrawal in patients with prolactinoma ( Table 2) show relatively high recurrence rates, comparable to our study.…”

Use of the Leksell gamma knife in the treatment of prolactinoma patients

“…This finding is very important, as permanent remission is reported in only 7-44% of patients after discontinuation of the dopamine agonists bromocriptine and cabergoline. 8,32,34,35,[37][38][39][40] Only Colao et al . 41 reported a higher success rate of cases in which remission was avoided after discontinuation of cabergoline: 70% in microprolactinoma patients and 64% in macroprolactinoma patients.…”