The recurrence of prolactinoma after withdrawal of dopamine agonist: a systematic review and meta-analysis

Zou, Yunzhi; Li, De-Pei; Gu, Jiayu; Chen, Siyu; Wen, Xiaozhong; Dong, Jiajun; Jiang, Xiaobing

doi:10.1186/s12902-021-00889-1

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Even when DAs treatment is discontinued as recommended, relapses after discontinuation of the drug occur in a significant proportion of patients. There is a variable rate of recurrence of prolactinomas (from 2% to 80%), which, apparently, is associated with the patients selection criteria, type of DAs used and duration of observation [ 49 ]. If more stringent criteria were applied before withdrawal, sustained remission occurred in more than 50% of patients [ 50 ].…”

Section: Prolactinoma Drug Therapy Regimens and Risks Of Its Relapsementioning

confidence: 99%

Current and Perspective Approaches to the Treatment of Prolactinomas

Barabash,

Tykhonova,

Kanishcheva

2023

AML

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Background: Along with the presence of the 2011 Endocrine Society Clinical Practice Guidelines and numerous large-scale studies on the treatment of hyperprolactinemia of different origin, there are some unresolved questions, ambiguous and sometimes contradictory points of view regarding the management of patients with prolactinomas. This overview is devoted to the analysis of the results of modern clinical studies and the approaches towards the management of hyperprolactinemia caused by prolactinoma.Materials and methods: A systematic research of the literature for the appropriate keywords published mainly for the last 10 years was done; also, a reference list of each selected article was analysed. We included to our review the articles reporting controversial issues or new data on the treatment of hyperprolactinemia.Results: The review describes various problems arising during the treatment of prolactinoma. The presence of primary and secondary dopamine agonist resistance in each case requires an individual approach, and sometimes may include the use of the antineoplastic agent temozolomide. The side effects of dopamine agonists are discussed, with quite rare ones, including valvulopathy, pathological psychological conditions and cerebrospinal rhinorrhea. The controversial issue of the duration and doses of the drug used to achieve a lasting effect in the treatment of prolactinomas is considered. There are some points connected with the frequency of relapses. Thus, recurrence is correlated to the duration of treatment with dopamine agonists, prolactin levels at diagnosis, and the initial tumor size. Metformin, somatostatin analogues, selective estrogen receptor modulators, tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin, epidermal growth factor receptor antagonists are investigated nowadays as potential alternative methods of drug treatment of prolactinomas. Conclusion: Drug therapy with dopamine agonists makes it possible to achieve the desired results in the vast majority of patients. However, despite the proven safety of this group of medicines, the risk of side effects should still be taken into account. The therapy regimen should be determined by the clinical course of prolactinoma and the patient’s response to treatment. Other options of treatment should be considered in patients intolerant to medical therapy, with contraindication or resistance to dopamine agonists, in the case of a malignant tumor. The presence of refractory to any of the applied methods of treatment and aggressive prolactinomas leads to the search for new drugs.

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Section: Prolactinoma Drug Therapy Regimens and Risks Of Its Relapsementioning

confidence: 99%

Current and Perspective Approaches to the Treatment of Prolactinomas

Barabash,

Tykhonova,

Kanishcheva

2023

AML

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“…24,25 However, male patients with persistent symptomatic prolactin elevation likely require long-term treatment with DA to prevent the hypogonadism state and its complications. 26,27…”

Section: Dopamine Agonist Therapymentioning

confidence: 99%

Rational Evaluation and Treatment of Prolactinomas: A Concise Review

Mahzari

2022

Journal of Diabetes and Endocrine Practice

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Prolactinoma is the most common pituitary tumor. It arises from the lactotroph cells and leads to a hyperprolactinemia state. The clinical presentation of prolactinomas is either due to the high prolactin state or the adenoma mass effect. Diagnosis of prolactinomas starts with the confirmation of persistent pathologic hyperprolactinemia. Subsequently, pituitary MRI is required to characterize the prolactinoma size and extension within the sella turcica. Further investigation may include visual field assessment and laboratory investigations for hypopituitarism. Prolactinoma management is mainly medical with dopamine agonists as most of these tumors are responsive. Surgical intervention is rarely required with specific indications.

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“…Medical treatment with dopamine agonists (DA) is the therapy of choice for PRL with humoral response, defined as normoprolactinemia in 68% of cases, tumor shrinkage in 62% of cases and relieving infertility or other symptoms in 53%, respectively (22,23). Recurrence of hyperprolactinemia after withdrawal of DAs varies widely among different studies between 2-80%, depending of the DA-type, treatment duration and initial tumor size (24,25). For patients who are intolerant or resistant to DA, surgery is the best option.…”

Section: Introductionmentioning

confidence: 99%

Metabolic and inflammatory parameters in relation to baseline characterization and treatment outcome in patients with prolactinoma: insights from a retrospective cohort study at a single tertiary center

Hofbauer,

Horka,

Seidenberg

et al. 2024

Front. Endocrinol.

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BackgroundProlactinomas (PRLs) are prevalent pituitary adenomas associated with metabolic changes and increased cardiovascular morbidity. This study examined clinical, endocrine, metabolic, and inflammatory profiles in PRL patients, aiming to identify potential prognostic markers.MethodsThe study comprised data from 59 PRL patients gathered in a registry at the University Hospital of Zurich. Diagnostic criteria included MRI findings and elevated serum prolactin levels. We assessed baseline and follow-up clinical demographics, metabolic markers, serum inflammation-based scores, and endocrine parameters. Treatment outcomes were evaluated based on prolactin normalization, tumor shrinkage, and cabergoline dosage.ResultsThe PRL cohort exhibited a higher prevalence of overweight/obesity, prediabetes/diabetes mellitus, and dyslipidemia compared to the general population. Significant correlations were found between PRL characteristics and BMI, HbA1c, and fT4 levels. Follow-up data indicated decreases in tumor size, tumor volume, prolactin levels, and LDL-cholesterol, alongside increases in fT4 and sex hormones levels. No significant associations were observed between baseline parameters and tumor shrinkage at follow-up. A positive association was noted between PRL size/volume and the time to achieve prolactin normalization, and a negative association with baseline fT4 levels.ConclusionThis study underscores the metabolic significance of PRL, with notable correlations between PRL parameters and metabolic indices. However, inflammatory markers were not significantly correlated with patient stratification or outcome prediction. These findings highlight the necessity for standardized follow-up protocols and further research into the metabolic pathogenesis in PRL patients.

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The recurrence of prolactinoma after withdrawal of dopamine agonist: a systematic review and meta-analysis

Cited by 5 publications

References 29 publications

Current and Perspective Approaches to the Treatment of Prolactinomas

Current and Perspective Approaches to the Treatment of Prolactinomas

Rational Evaluation and Treatment of Prolactinomas: A Concise Review

Metabolic and inflammatory parameters in relation to baseline characterization and treatment outcome in patients with prolactinoma: insights from a retrospective cohort study at a single tertiary center

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