Recurrence of Hyperprolactinemia After Withdrawal of Long-Term Cabergoline Therapy

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

“…Although consistent with the early recurrence of hyperprolactinaemia, our data show higher rates of recurrence (64% for microprolactinomas and 93% for macroprolactinomas) than those reported by Kharlip and colleagues. 11 Predictors for recurrence reported by Kharlip included the size of pituitary tumour remnant prior to DA withdrawal and, as in our study, prolactin nadir during DA treatment. 11 Other studies have shown comparable recurrence rates to those that we demonstrate in our data: Cannavo and colleagues reported an 81AE5% recurrence rate at 1 year following DA withdrawal in unselected patients (n = 27) with both macroprolactinomas and microprolactinomas 18 ; Biswas and colleagues reported on 67 patients with microprolactinoma with a recurrence rate of 68AE7%.…”

“…These data are consistent with those of Kharlip and colleagues. 11 When the Pituitary Society guidelines on management of prolactinoma were formulated in 2006, 10 one of the major studies in this field (and on which recommendations were based) was published by Colao and colleagues. 13 This study included 200 patients with hyperprolactinaemia (105 with microprolactinoma and 70 macroprolactinoma) who had been carefully chosen for cabergoline withdrawal following a period of treatment.…”

“…15 The recurrence rates for hyperprolactinaemia following DA withdrawal in prolactinomas are much higher in the Dekkers meta-analysis 15 than those reported by Calao and colleagues. 13,14 Kharlip and colleagues 11 reported data on microprolactinomas (n = 31) and macroprolactinomas (n = 11) with a median duration of treatment of 4AE3 years, and all of whom had met Pituitary Society criteria for withdrawal of DA therapy. 10 Recurrence of hyperprolactinaemia occurred in 52% of the microprolactinomas and 55% of the macroprolactinomas, each after a median duration of 3 months following withdrawal of DA therapy.…”

“…10 Although it is clear that most patients with prolactinoma respond well to DA therapies, what is less clear is the optimal duration of DA therapy in patients with microprolactinoma and macroprolactinoma: it has been reported that >50% of patients with prolactinoma have an early recurrence of hyperprolactinaemia following discontinuation of DA therapy with prior treatment for at least 2 years. 11 This is an important unanswered question and one that has relevant clinical implications for practising endocrinologists. The current literature is not clear in this field, and there is no clear evidence from prospectively randomized studies to support an optimal duration of DA therapy on which practical guidelines can be based.…”

Dopamine agonist withdrawal in hyperprolactinemia: when and how

“…Their data showed that more than half of patients on low dose cabergoline (≤0.5 mg per week) can safely stop the drug, and recommend withdrawal in patients who have been on cabergoline for at least 2 years, whose prolactin has been low (≤10 ng/mL) for one year, and have achieved significant tumor size reduction. Although not specifically reported in this meta-analysis, a further reassuring factor that should convince clinicians to make at least one attempt to stop cabergoline is that, when withdrawal is not successful, serum prolactin increase occurs before any visible increase in tumor size by MRI [6,12].…”