Prolactinomas diagnosed in the postmenopausal period: Clinical phenotype and outcomes

Santharam, Sandhya; Tampourlou, Metaxia; Arlt, Wiebke; Ayuk, John; Gittoes, Neil; Toogood, Andrew; Webster, Rachel; Karavitaki, Niki

doi:10.1111/cen.13399

Cited by 22 publications

(11 citation statements)

References 30 publications

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“…These findings demonstrate that the growth potential of the prolactinomas remains even after menopause. In accord with this is the observation that 94% of the prolactinomas diagnosed after menopause are macroadenomas . Furthermore, the long interval until detection of tumour regrowth signifies the importance of prolonged monitoring in cases with persistent hyperprolactinaemia.…”

Section: Discussionmentioning

confidence: 78%

Impact of menopause on outcomes in prolactinomas after dopamine agonist treatment withdrawal

Santharam

Fountas

Tampourlou

et al. 2018

Clinical Endocrinology

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Section: Discussionmentioning

confidence: 78%

Impact of menopause on outcomes in prolactinomas after dopamine agonist treatment withdrawal

Santharam

Fountas

Tampourlou

et al. 2018

Clinical Endocrinology

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“…Santharam et al 12 included only women with prolactinomas diagnosed during the postmenopausal period ( n = 17). In the present study, the diagnosis of prolactinoma was investigated in women with HPRL.…”

Section: Resultsmentioning

confidence: 99%

“…Santharam et al 12 described microadenoma ( n = 1) and macroadenoma ( n = 16) diagnosed during the postmenopausal period. Tumor shrinkage has been reported to be 25% after treatment with various DAs.…”

Section: Resultsmentioning

confidence: 99%

Prolactinoma in postmenopausal women: a systematic review

Carneiro,

de Mira,

Yela

et al. 2024

Menopause

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Importance Prolactinomas occurring during the reproductive period exhibit a characteristic behavior. There are, however, gaps in the literature regarding the behavior of these tumors after menopause. Objective This study aimed to review and characterize the influence of menopause on prolactinoma behavior. Evidence review A systematic review of observational prospective or retrospective studies and clinical trials on prolactinomas was conducted in two situations: tumors diagnosed in the reproductive period (before menopause), with follow-up in the postmenopausal period, or prolactinomas diagnosed in the postmenopausal period, without language or date restrictions. Data extracted from the articles included patient and tumor characteristics (prolactinoma type, previous treatment, symptoms, and serum prolactin [PRL] levels). Findings This study included five studies comprising 180 participants. Prolactinomas diagnosed in women of reproductive age are treated with dopaminergic agonists (DAs), with indications of treatment withdrawal after menopause, exhibited stable tumor behavior and PRL levels. Considering the diagnosis during the postmenopausal period, macroprolactinomas were more prevalent and showed tumor shrinkage when DAs were used. Cabergoline, the most commonly used drug, lowers PRL levels and reduces symptoms associated with adenoma. Conclusions and Relevance Microadenomas diagnosed before menopause can be followed up without treatment. Prolactinomas diagnosed after menopause are typically macroadenomas. Cabergoline remains the treatment of choice in the presence of clinical or compressive symptoms. We recommend at least one annual follow-up for such patients.

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“…A total of 81 studies [ 4 – 8 , 13 , 68 , 84 , 92 – 97 , 99 – 112 , 114 , 118 , 120 – 123 , 125 , 127 – 133 , 135 – 137 , 139 , 141 – 156 ] comprising 4397 patients who received surgery and 74 studies [ 3 – 6 , 8 , 13 , 17 – 21 , 25 , 26 , 28 – 36 , 38 , 42 – 46 , 48 – 51 , 54 – 58 , 60 , 61 , 65 – 73 , 76 , 79 – 81 , 85 – 87 , 89 , 91 ] comprising 2659 patients who used DAs were included in this part of the research. The pooled prolactin normalization rates were 0.66 (0.62, 0.71) ( I 2 = 93.8%, p = 0.000) in the surgery group and 0.78 (0.75, 0.82) ( I 2 = 89.4%, p = 0.000) in the DAs group, respectively (Fig.…”

Section: Resultsmentioning

confidence: 99%

Are dopamine agonists still the first-choice treatment for prolactinoma in the era of endoscopy? A systematic review and meta-analysis

et al. 2022

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Background For prolactinoma patients, dopamine agonists (DAs) are indicated as the first-line treatment and surgery is an adjunctive choice. However, with the development of surgical technique and equipment, the effect of surgery has improved. The aim of this study was to assess the efficacy and safety of surgery versus DAs in patients with different types of prolactinomas. Methods A systematic search of literature using Web of Science, PubMed, Cochrane Library, and Clinical Trial databases was conducted until July 12, 2019. Prolactinoma patients treated with DAs (bromocriptine or cabergoline) or surgery (microscopic or endoscopic surgery) were included. Outcomes included the biochemical cure rate, recurrence rate, prolactin level, improvement rates of symptoms, and incidence rates of complications. A random-effects model was used to pool the extracted data. Qualitative comparisons were conducted instead of quantitative comparison. Results DAs were better than surgery in terms of the biochemical cure rate (0.78 versus 0.66), but surgery had a much lower recurrence rate (0.19 versus 0.57). Full advantages were not demonstrated in improvement rates of symptoms and incidence rates of complications with both treatment options. In microprolactinoma patients, the biochemical cure rate of endoscopic surgery was equal to the average cure rate of DAs (0.86 versus 0.86) and it surpassed the biochemical cure rate of bromocriptine (0.86 versus 0.76). In macroprolactinoma patients, endoscopic surgery was slightly higher than bromocriptine (0.66 versus 0.64) in terms of the biochemical cure rate. Conclusion For patients with clear indications or contraindications for surgery, choosing surgery or DAs accordingly is unequivocal. However, for patients with clinical equipoise, such as surgery, especially endoscopic surgery, in microprolactinoma and macroprolactinoma patients, we suggest that neurosurgeons and endocrinologists conduct high-quality clinical trials to address the clinical equipoise quantitatively.

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Prolactinomas diagnosed in the postmenopausal period: Clinical phenotype and outcomes

Cited by 22 publications

References 30 publications

Impact of menopause on outcomes in prolactinomas after dopamine agonist treatment withdrawal

Impact of menopause on outcomes in prolactinomas after dopamine agonist treatment withdrawal

Prolactinoma in postmenopausal women: a systematic review

Are dopamine agonists still the first-choice treatment for prolactinoma in the era of endoscopy? A systematic review and meta-analysis

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