Predictors of remission of hyperprolactinaemia after long‐term withdrawal of cabergoline therapy

Colao, Annamaria; Sarno, Antonella Di; Guerra, Ermelinda; Pivonello, Rosario; Cappabianca, Paolo; Caranci, Ferdinando; Elefante, Andrea; Cavallo, Luigi Maria; Briganti, Francesco; Cirillo, S.; Lombardi, Gaetano

doi:10.1111/j.1365-2265.2007.02905.x

Cited by 101 publications

(108 citation statements)

References 56 publications

(127 reference statements)

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“…To sum up, male sex does not exert crucial effect on surgical outcomes of prolactinomas. However, male gender was found to be closely associated with recurrence of hyperprolactinemia after DA withdrawal by Colao et al (5). In the present study, the preoperative PRL level and tumor invasion were found to be associated with early poor surgical outcomes by multivariate analysis, in line with most of the previous literature (16,17,22).…”

Section: Discussionsupporting

confidence: 90%

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Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

Qu¹,

Wang²,

Wang³

et al. 2011

European Journal of Endocrinology

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Context: Little systematic data on male prolactinomas treated with surgery are available. Objective: To clarify the clinical features and confirm the efficacy of transsphenoidal surgery for male prolactinomas and predictive factors after initial surgery. Patients and methods: This retrospective study included 87 male patients with prolactinoma treated by transsphenoidal surgery at an academic medical center. Hormonal and visual status, remission rates, and the rate of tumor relapse, as well as predictive factors, were evaluated. Results: Postoperative initial remission was achieved in 52.9% of patients. The remission rate was markedly higher in microadenomas (83.3%) than in macroadenomas (44.9%). Logistic regression analysis showed that the predictive factors of the early negative outcomes were high preoperative prolactin (PRL) levels and tumor invasion. After a median follow-up of 45 months, the long-term remission rate was 42.5%, and relapse of hyperprolactinemia occurred in 19.6% of the cured patients. The 5-year recurrence-free survival was 78.2% (95% confidence interval, 62.3-88.1%). When surgery was followed by adjuvant treatment in uncured and recurrent patients, 78.8% of patients in the entire group in the absence of dopamine agonists obtained biochemical remission at the end of follow-up. Conclusion: Transsphenoidal surgery is a viable treatment alternative for male prolactinomas. The remission rates of male patients with microadenomas and/or intrasellar macroprolactinomas by surgery alone remain excellent, and surgery followed by adjuvant therapy as necessary is required for optimizing management of male prolactinomas, especially for extrasellar macroprolactinomas. The early negative results are associated with preoperative PRL levels and tumor invasion.

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Section: Discussionsupporting

confidence: 90%

“…Of these patients, 60.4% achieved normalization of PRL concentration, which was slightly lower than the previous report of a mixed series (16). At the latest follow-up, the total remission rate of our series might be superior to that of withdrawal of medication therapy (5,6).…”

Section: Discussioncontrasting

confidence: 70%

Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

Qu¹,

Wang²,

Wang³

et al. 2011

European Journal of Endocrinology

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“…Згідно з дослідженнями, проведеними А. Соlа і співавт., лікування САВ протягом 24 місяців з вико-ристанням середньої терапевтичної дози препара-ту 1,5 мг у хворих з макроПРОЛ і 1 мг з мікроПРОЛ щотижня призводило до нормалізації рівня ПРЛ як у жінок, так і в переважної більшості чоловіків [30]. У дослідженні відзначалася задовільна пере-носимість САВ, побічні ефекти терапії були зареєстровані у 4,5% досліджуваних.…”

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Anti-proliferative effects of high doses cabergoline in patients with organic hyperprolactinemia

Хижняк¹,

Gogitidze²,

Микитюк³

2015

CE&ES

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“…29 Studies in which discontinuation of treatment was attempted showed a great spectrum of results, as normoprolactinaemia was maintained from as low as 0 to 6% to as high as 50 to 60% of cases over a period of 12 to 60 months after withdrawal. [34][35][36][37][38] Drawing conclusions from these studies is difficult because not all were prospective and most of them included micro-and macroadenomas and patients who had undergone neurosurgery or had received radiotherapy. However, certain of these studies observed that post-withdrawal hyperprolactinaemia was lower than that at the onset of treatment and that extending the period of treatment with dopamine agonists resulted in longer phases of remission.…”

mentioning

confidence: 99%

Extensive personal experience. Validation of prolactin levels in menstrual disorders and in prolactinomas

Batrinos¹

2009

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It is now well established that hyperprolactinaemia is not rare and in the majority of cases is caused by a pituitary tumor, a prolactinoma. [1][2][3][4] However, despite a plethora of relevant publications there are still certain questions that have not been adequately addressed: 1. What is the upper normal level of serum prolactin beyond which the condition should be characterized as hyperprolactinaemia requiring evaluation by imaging. 2. What is the incidence of non-secreting adenomas of the pituitary that might be erroneously regarded as prolactinomas. 3. How long should medical treatment be continued in the case of a prolactinoma. In this communication an attempt is made to critically analyze results on prolactinaemia obtained in our laboratory over a long time period, a sort of "meta-analysis" of our previously published data, 5,6 aiming at reaching certain conclusions with practical implications for the clinician. Particular emphasis is placed on the prolactin levels in various menstrual disorders observed in 2500 women.The serum prolactin (PRL) level that warrants imaging investigation is controversial. Some authors Key words: Galactorrhoea, Hyperprolactinaemia, Menstrual disorders, Prolactinomas suggest evaluation only if the PRL value is >50 or >100μg/L, whereas most investigators rely on the upper limit of the reference range quoted in the commonly used commercial assays. These assays, however, are based on measurements performed in a limited number of persons and for this reason many Endocrine Centers prefer to create reference ranges of serum prolactin values based on their own normal or patient populations, a routine that has also been our policy. During a period of 12 years we have measured serum prolactin along with other hormones in 4199 women aged 14 to 43 years who presented at the Endocrine Unit of the Department of Pharmacology of the Athens Medical School with various endocrine disorders (Table 1).Of the 4199 women, 753 who were examined for infertility of the couple due mainly to male infertility had normal cycles and no clinically manifest endocrine disorder and can be considered as a sample of the normal population. The distribution frequency of serum prolactin values in this group shows a bellshaped curve positively skewed with 94.8% of the values between 1 and 20μg/L and a tail of scattered values up to 30μg/L. In the 11 cases with prolactin between 30 and 50μg/L three prolactinomas were found, while three of the four cases with prolactin over 50μg/L had a prolactinoma (Figure 1).Five hundred and nineteen patients examined for hirsutism with normal ovulatory cycles showed the same pattern of frequency distribution of prolactin, with 95.5% of the values within the range of 1 to 20μg/L and a few values over 20μg/L in which no

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Predictors of remission of hyperprolactinaemia after long‐term withdrawal of cabergoline therapy

Cited by 101 publications

References 56 publications

Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases

Anti-proliferative effects of high doses cabergoline in patients with organic hyperprolactinemia

Extensive personal experience. Validation of prolactin levels in menstrual disorders and in prolactinomas

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