Withdrawal of dopamine agonist therapy in prolactinomas: In which patients and when?

Dogansen, Sema Ciftci; Selçukbiricik, Özlem Soyluk; Tanrikulu, Seher; Yarman, Sema

doi:10.1007/s11102-016-0708-3

Cited by 30 publications

(50 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of association that we found between CBG withdrawal's outcomes and complete tumor regression, treatment duration, or cumulative CBG doses is concordant with other previously published research [23,25,33]. In particular, given the unclear role of treatment duration on microprolactinomas' outcomes, we decided to include in the present study patients treated with CBG for at least one year, although most recent guidelines [2,3] recommend a 2-3-year treatment before drug withdrawal.…”

Section: Discussionsupporting

confidence: 86%

“…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%

“…The sample size is quite small, however comparable with that of previously published research on prolactinomas in postmenopausal women, and we recognize that this could have partly influenced the negative results. Another limitation is the short follow-up time; even if it is well-known that most patients relapse within the first year after drug withdrawal [25,33], longer time may be needed to better understand prolactinoma's natural course.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The higher success rates of this study were attributed to stricter selection criteria for CAB withdrawal, including a prolonged period of normoprolactinemia during treatment and a significant tumor size reduction (161,162). Since 2003, several studies have evaluated the recurrence rates of hyperprolactinemia after DA withdrawal with variable results (162)(163)(164)(165)(166)(167)(168)(169)(170).…”

Section: Withdrawal Of the Dopamine Agonist -Why When How And How Omentioning

confidence: 96%

“…Patients who received the lowest CAB dose and presented a significant reduction in tumor size before withdrawal were more likely to benefit from CAB withdrawal (p < 0.001) (172). In three recent studies, the recurrence rates after CAB withdrawal ranged from 27% to 54% (168)(169)(170). Among 74 patients (19 MACs and 55 MICs) treated with CAB for ≥ 3 years, recurrences occurred within 12 months in 34 (45.9%), regardless of the previous duration of CAB therapy (up to 3 yrs, 3 to 5 yrs or > 5 yrs) or initial adenoma size (168).…”

Section: Withdrawal Of the Dopamine Agonist -Why When How And How Omentioning

confidence: 99%

Controversial issues in the management of hyperprolactinemia and prolactinomas – An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Vilar¹,

Abucham²,

Albuquerque³

et al. 2018

Archives of Endocrinology and Metabolism

102

View full text Add to dashboard Cite

Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.

show abstract

Treatment of sexual dysfunction induced by hyperprolactinemia accompanied by reduced luteinizing hormone levels: A case report

Liu,

Jia,

2024

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageSexual dysfunction induced by hyperprolactinemia accompanied by reduced luteinizing hormone (LH) is common in anrology clinics. A low dose of bromocriptine is helpful for restoring penile erectile function and libido in patients.AbstractSexual dysfunction is closely related to hormonal disorders, of which prolactin (PRL) and luteinizing hormone (LH) disorders are common. How to treat sexual dysfunction induced by hyperprolactinemia accompanied by reduced LH levels is worth discussing. In this study, we aimed to present the case of a 35‐year‐old male patient with sexual dysfunction. The treatment process and physical and laboratory examination results were recorded. Before treatment, the PRL and LH levels in this patient were 31.27 ng/mL and 1.62 mIU/mL, respectively. The International Index of Erectile Function‐5 (IIEF‐5) score was initially 14 points. After regular treatment with low doses of bromocriptine and tadalafil, the hormonal disorder was corrected (PRL: 11.16 ng/mL and LH: 2.28 mIU/mL) and sexual function was recovered (IIEF‐5: 23 points). This case report suggested a sufficient exposure to low‐dose bromocriptine for such patients. Conversely, the exogenous supplementation of human chorionic gonadotropin may not be appropriate.

show abstract

Withdrawal of dopamine agonist therapy in prolactinomas: In which patients and when?

Cited by 30 publications

References 39 publications

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

Controversial issues in the management of hyperprolactinemia and prolactinomas – An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Treatment of sexual dysfunction induced by hyperprolactinemia accompanied by reduced luteinizing hormone levels: A case report

Contact Info

Product

Resources

About