Prolactinoma management: predictors of remission and recurrence after dopamine agonists withdrawal

Teixeira, Margarida I.; Souteiro, Pedro; Carvalho, Davide

doi:10.1007/s11102-017-0806-x

Cited by 24 publications

(23 citation statements)

References 24 publications

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“…There were 8 articles without full text and most of them were recorded in EMBASE database exclusively. After assessment with eligibility criteria in detail, 13 publications with total 809 patients were included in the final meta-analysis ( 9 – 11 , 20 – 29 ). Details of the 13 articles are summarized in Table 1 .…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…The best candidates for dopamine agonist withdrawal are patients who have no visible tumor on MRI, have a nadir prolactin level < 1.0 ng/dL during drug treatment, and those who received drug treatment for more than 6 years [8]. Among patients successfully treated with dopamine agonists, follow-up after 24 months of treatment withdrawal showed that approximately 60-70% remained in remission [4,8]. As of this writing, there are no definite guidelines with regards to the duration of surveillance of prolactin levels among patients in remission.…”

Section: Discussionmentioning

confidence: 99%

“…The more common effects manifested by prolactinomas include headache and visual field impairment, loss of libido, infertility, osteoporosis in both sex-es, menstrual irregularities and galactorrhea in females, and erectile dysfunction in males [1,3]. Dopamine agonists are the principal treatment, but data on prolactinoma remission and relapse after treatment withdrawal remain limited [1,4].…”

Section: Introductionmentioning

confidence: 99%

The Vanishing Pituitary Tumor: A Case Report

Lee¹,

Chua²,

Ramos

2021

J Endocrinol Metab

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Prolactinomas are the most common functional pituitary tumors and present with elevated serum prolactin levels. This may or may not be accompanied by mass-related clinical symptoms. Dopamine agonists are its principal treatment. Data on prolactinoma remission and relapse after treatment withdrawal are limited. Here we report a patient presenting with headache, amenorrhea, galactorrhea, visual field impairments and a high serum prolactin level. After a definitive diagnosis of pituitary macroadenoma, the patient was treated with bromocriptine. Twelve months after treatment, tumor size markedly reduced, there was resolution of symptoms and patient was eventually lost to follow-up. After 10 months without treatment, tumor recurred. Bromocriptine was resumed for 5 more years and discontinued thereafter. Since then, the patient has been asymptomatic for the past 12 years; surveillance imaging showed no tumor recurrence with annual prolactin level all within normal range. This case adds to the limited data confirming that dopamine agonists in patients with prolactinomas can be successfully discontinued with a high remission rate, provided that there is adequate duration of treatment and sufficient follow-up.

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“…In literature, many clinical, biochemical, and radiological characteristics have been investigated as potentially predictive factors for long-term remission in prolactinomas, like treatment duration, complete tumor regression before withdrawal, and nadir PRL reached during dopamine agonist treatment [22,25,26,[33][34][35], and some were included by most recent guidelines as criteria for drug withdrawal [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…Which clinical, biochemical, and radiological features, if any, can reliably predict long-term outcome in microprolactinomas remains unclear [22][23][24][25][26]; a better understanding of these aspects is important to help optimize the management of patients with microprolactinoma and may provide an insight in the underlying pathogenetic mechanisms. In order to verify if estrogenic exposure plays a role in microprolactinoma's recurrence, the aims of the present study were: (1) to analyze clinical, biochemical, and radiological characteristics of patients with microprolactinomas in long-term remission after CBG withdrawal, compared with those experiencing hyperprolactinemia recurrence; (2) to compare recurrence rates after CBG withdrawal in premenopausal and in postmenopausal women; (3) to investigate which factors, including the postmenopausal status, were able to predict the long-term outcomes in both the whole study population and specifically in the postmenopausal group.…”

Section: Introductionmentioning

confidence: 99%

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

et al. 2019

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Natural course of prolactinomas after menopause is not fully elucidated. The aim of this study was to compare recurrence rate after cabergoline withdrawal in premenopausal vs. postmenopausal women with microprolactinoma. Sixty-two women with microprolactinoma treated with cabergoline for at least 1 year and followed for 2 years after drug withdrawal were retrospectively selected. Patients were divided into two groups: 48 patients stopped cabergoline before menopause (BPRE^group), while 14 after menopause (BPOST^group). Recurrence was defined by prolactin levels above normal, confirmed on two occasions. Overall, 39/62 women relapsed. Patients who relapsed apparently had higher prolactin before withdrawal (median 216.2, range 21.2-464.3 mIU/L) compared with those in long-term remission (94.3, 29.7-402.8 mIU/L; p < 0.05), and the risk of recurrence seemed lower in POST women (4/14, 29%) than in PRE ones (35/48, 73%, p < 0.005, OR 0.149, 95% CI 0.040-0.558). However, none of the factors (prolactin before withdrawal, menopausal status, treatment duration, complete adenoma regression) showed a correlation with recurrence risk in multivariate analysis. The best strategy able to optimize CBG treatment and withdrawal's outcomes is still to be defined in microprolactinomas. Postmenopausal status cannot reliably predict long-term remission, and follow-up is needed also in women of this age.

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Prolactinoma management: predictors of remission and recurrence after dopamine agonists withdrawal

Abstract: We found a low percentage of attempt of withdrawal of DA therapy in the subjects with prolactinoma. Our data confirms that DA therapy can be discontinued with a high remission rate. Tumour size was the main variable that affected the withdrawal outcome in our patients.

Cited by 24 publications

References 24 publications

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

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

The Vanishing Pituitary Tumor: A Case Report

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

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