Recurrence of hyperprolactinaemia following discontinuation of dopamine agonist therapy in patients with prolactinoma occurs commonly especially in macroprolactinoma

Abstract

In routine practice, hyperprolactinaemia recurs early in most macroprolactinomas (93%) and microprolactinomas (64%) following DA therapy discontinuation. For most macroprolactinomas, cessation of DA cannot be recommended even after 7 years of therapy.

Update on prolactinomas. Part 2: Treatment and management strategies

“…found recurrence rates as high as 93% for macroprolactinomas and 64% for microprolactinomas [34]. Hyperprolactinemia recurrence is most commonly observed during the first 6 months to 1 year following cessation [34][35][36][37].…”

“…Regular follow-ups are necessary at 3 month intervals for the first year, then annually for at least 5 years post withdrawal, to monitor prolactin levels and tumor recurrence [12,29]. Macroprolactinoma patients who discontinue therapy should be carefully monitored with an MRI 6 months post withdrawal and annually thereafter, as there is a higher recurrence rate [26,34,36]. A study by Barber et al.…”

“…The outcomes of sustained normoprolactinemia after dopamine agonist therapy withdrawal have been variable, ranging from 7% to greater than 50% [2,[33][34][35][36][37]. Studies have described dopaminergic therapy cessation as safe, although, hyperprolactinemia relapse and tumor growth after discontinuation of dopamine agonist therapy is common [12,33,35,36] [38].…”

“…Therefore, the recurrence of hyperprolactinemia after withdrawal of dopamine agonist therapy occurs in a substantial proportion of patients [33]. It should be noted that most studies evaluate withdrawal on a selected group of patients that strictly meet clinical criteria, as described below [33,34,37].…”

“…Drug withdrawal may be attempted after about 4 years of dopamine agonist therapy [12,19]. Some studies have shown that a longer treatment duration and the use of cabergoline were associated with a greater remission rate [28,33], while some studies have not shown this [34,37]. The dosage of the dopamine agonist should be gradually decreased, while maintaining normal prolactin levels, until the drug is completely discontinued [12].…”