Management of prolactinomas in Brazil: an electronic survey

Vilar, Lúcio; Naves, Luciana Ansaneli; Casulari, Luíz Augusto; Azevedo, Monalisa F.; Albuquerque, José de Lima; Serfaty, Fabiano Marcel; Barbosa, Flávia Regina; Oliveira, Antônio Ribeiro de; Montenegro, Renan Magalhães; Ramos, Aline Sharlon Maciel Batista; Faria, Manuel dos Santos; Musolino, Nina Rosa de Castro; Gadelha, Mônica R.; Boguszewski, César Luiz; Bronstein, Marcello D.

doi:10.1007/s11102-010-0217-8

Cited by 10 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A similar study conducted in Brazil has been previously published [32]. In the case of pregnancy, only 58 % and 70 % of respondents advocated discontinuation of treatment with dopamine agonists in patients with macroprolactinomas and microprolactinomas, respectively.…”

Section: What Are the Current Trends In The Management Of Prolactinommentioning

confidence: 56%

“…In the case of pregnancy, only 58 % and 70 % of respondents advocated discontinuation of treatment with dopamine agonists in patients with macroprolactinomas and microprolactinomas, respectively. Finally, only 36 % would allow breast-feeding without restriction, 44 % would restrict it to patients with microprolactinomas, and 20 % would not recommend it for women with prolactinomas [32].…”

Section: What Are the Current Trends In The Management Of Prolactinommentioning

confidence: 99%

See 1 more Smart Citation

Pregnancy and Tumor Outcomes in Women with Prolactinoma

Araújo

Belo

Carvalho

2017

Exp Clin Endocrinol Diabetes

View full text Add to dashboard Cite

Management of prolactinomas during pregnancy has always been a challenge. There is a concern about the risk of tumor growth, as well as the effects of the treatment on the developing fetus. Another issue that has been less studied is the outcome of women with prolactinoma after pregnancy and lactation. To evaluate remission of hyperprolactinaemia after pregnancy and lactation in women with prolactinoma. To describe the safety of dopamine agonists for the fetus and pregnancy outcomes. A retrospective study of 32 pregnancies in women with prolactinoma was conducted in a single-centre. Other causes of hyperprolactinemia were excluded. Prolactin level was recorded at the time of diagnosis, during treatment, and during follow-up. The pregnancies resulted in one spontaneous abortion (3.1%) and 31 live births (96.9%). No stillbirths, multiple or ectopic pregnancies or trophoblastic disease were recorded. There was only one malformation (club foot) recorded (3.1%) and normalisation of prolactin after pregnancy without medical treatment occurred in 12% of patients. Fetal exposure to bromocriptine or cabergoline during pregnancy is not associated with an increased risk of adverse neonatal or pregnancy disclosures. There is considerable diversity among endocrinologists in the management of prolactinomas during pregnancy and after birth, which indicates that there is a need for better consensus and for carefully drawn-up guidelines to follow.

show abstract

Section: What Are the Current Trends In The Management Of Prolactinommentioning

confidence: 56%

Section: What Are the Current Trends In The Management Of Prolactinommentioning

confidence: 99%

Pregnancy and Tumor Outcomes in Women with Prolactinoma

Araújo

Belo

Carvalho

2017

Exp Clin Endocrinol Diabetes

View full text Add to dashboard Cite

show abstract

“… The data of Brazil and MENA are derived from Ref. ( 4 , 5 ) respectively. P values using the Chi-square test (or Fisher’s exact test).…”

Section: Resultsmentioning

confidence: 99%

“…However, in the current clinical practice, there are still controversies concerning appropriate diagnosis and treatment of prolactinoma, such as the identification of hyperprolactinemia, the choice of treatment methods, the duration of drug treatment and management of pregnancy and breastfeeding. In recent years, two studies have conducted questionnaire surveys of clinicians’ management of prolactinomas reflecting self-reported clinical diagnoses and treatment ( 4 , 5 ). However, no similar data are available from China.…”

Section: Introductionmentioning

confidence: 99%

Management of prolactinoma: a survey of endocrinologists in China

Zhang

et al. 2018

Endocrine Connections

View full text Add to dashboard Cite

ObjectiveTo assess the current management of prolactinoma among endocrinologists in China.MethodsAn online survey of a large sample of endocrinologists was conducted in China. The questionnaire included 21 questions related to controversial issues about the management of prolactinomas. Doctors in the endocrinology department of a university-affiliated hospital or a comprehensive secondary hospital in 12 cities from East, West, South, North and Middle China were surveyed.ResultsA total of 290 valid questionnaires were collected, and the response rate was 40%. When hyperprolactinemia occurred, 97% of the respondents would test thyroid-stimulating hormone routinely. 22% of the respondents considered that prolactin levels <100 ng/mL exclude the presence of a prolactinoma. Only 9% of the respondents believed that prolactin >250 ng/mL could occur in all the following situations as macroprolactinoma, mircoprolactinoma, macroprolactinemia and drug-induced hyperprolactinemia. Surgery was not recommended by 272 (94%) endocrinologists as the first choice for treating microprolactinomas. 58% and 92% of endocrinologists would start drug treatment for microprolactinomas and macroprolactinomas at diagnosis. 70% and 40% chose to withdraw treatment after 2–3 years of prolactin normalization in microprolactinomas and macroprolactinomas. In case of pregnancy, 57% of the respondents considered bromocriptine as choice for women patients. Drug discontinuation after pregnancy was advocated in 63% and 27% for microprolactinoma and macroprolactinoma. Moreover, 44% of endocrinologists believed that breastfeeding was allowable in both micro- and macroprolactinoma.ConclusionThis is the first study to investigate the management of prolactinomas among endocrinologists in China. We found that the current clinical treatment was not uniform. Therefore, it is necessary to strengthen the training of endocrinologists to improve clinical diagnosis and treatment practices.

show abstract

“…The optimal duration of therapy with DA for patients with prolactinomas or non-tumoral hyperprolactinemia remains controversial ( 12 ). There is however strong and growing evidence that discontinuation of dopamine agonist treatment may be successfully achieved in a selected group of patients treated for at least 2 years ( 14 – 17 , 19 , 20 ). A recent systematic review and meta-analysis has shown that the pooled proportion of patients with persisting normoprolactinemia after CAB withdrawal was 35% in a random effects model ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Second Attempt of Cabergoline Withdrawal in Patients with Prolactinomas after a Failed First Attempt: Is it Worthwhile?

et al. 2015

Self Cite

View full text Add to dashboard Cite

Successful discontinuation of cabergoline (CAB) treatment has been reported in 31–75% of prolactinomas patients treated for at least 2 years. In contrast, it is not well established whether CAB therapy can be successfully withdrawn after a failed first attempt. This prospective open trial was designed to address this topic and to try to identify possible predictor factors. Among 180 patients with prolactinomas on CAB therapy, the authors selected those who fulfilled very strict criteria, particularly additional CAB therapy for at least 2 years, normalization of serum prolactin (PRL) levels following CAB restart, no tumor remnant >10 mm, no previous pituitary radiotherapy or surgery; and current CAB dose ≤1.0 mg/week. Recurrence was defined as an increase of PRL levels above the upper limit of normal. A total of 34 patients (70.6% female) treated with CAB for 24–30 months were recruited. Ten patients (29.4%) remained without evidence of recurrence after 24–26 months of follow-up. Twenty-four patients (70.6%) recurred within 15 months (75% within 12 months) after drug withdrawal and ~80% were restarted CAB. Median time to recurrence was 10.5 months (range, 3–15). Despite overlapping values, non-recurring patients had significantly lower mean PRL levels before withdrawal. Moreover, the recurrence rate was lower in subjects without visible tumor on pituitary magnetic resonance imaging (MRI) than in those with small remnant tumor (60 vs. 79%), though the difference was not statistically significant (P = 0.20). No other characteristic could be identified as a predictor of successful CAB discontinuation. In conclusion, a second attempt of CAB withdrawal after two additional years of therapy may be successful, particularly in patients with lower PRL levels and no visible tumor on pituitary MRI. Close monitoring of PRL level is mandatory, especially within the first year after withdrawal, where most recurrences are detected.

show abstract

Management of prolactinomas in Brazil: an electronic survey

Cited by 10 publications

References 39 publications

Pregnancy and Tumor Outcomes in Women with Prolactinoma

Pregnancy and Tumor Outcomes in Women with Prolactinoma

Management of prolactinoma: a survey of endocrinologists in China

Second Attempt of Cabergoline Withdrawal in Patients with Prolactinomas after a Failed First Attempt: Is it Worthwhile?

Contact Info

Product

Resources

About