Recurrence of hyperprolactinemia following dopamine agonist withdrawal and possible predictive factors of recurrence in prolactinomas

Abstract

The study provides additional evidence that prolonging therapy for more than 3 years does not reduce recurrence rate. In particular, recurrence risk was similar in micro- and macroadenomas, and higher in patients with pituitary deficits at diagnosis.

Cabergoline Withdrawal Before and After Menopause: Outcomes in Microprolactinomas

“…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.…”

“…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].…”

“…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.…”

“…Which clinical, biochemical, and radiological features, if any, can reliably predict long-term outcome in microprolactinomas remains unclear [22][23][24][25][26]; a better understanding of these aspects is important to help optimize the management of patients with microprolactinoma and may provide an insight in the underlying pathogenetic mechanisms. In order to verify if estrogenic exposure plays a role in microprolactinoma's recurrence, the aims of the present study were: (1) to analyze clinical, biochemical, and radiological characteristics of patients with microprolactinomas in long-term remission after CBG withdrawal, compared with those experiencing hyperprolactinemia recurrence; (2) to compare recurrence rates after CBG withdrawal in premenopausal and in postmenopausal women; (3) to investigate which factors, including the postmenopausal status, were able to predict the long-term outcomes in both the whole study population and specifically in the postmenopausal group.…”

MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment

“…Transphenoidal surgery can be discussed either as a firstor second-line treatment to cure the patient and/or to decrease prolactin levels to enhance the efficacy of the DA. However, results on the possibility of DA withdrawal, as proposed in the case of microprolactinoma, are still controversial (6,14). According to the Endocrine Society guidelines on prolactinomas (2, 13) there is still a lack of strong recommendation to propose DA withdrawal in case of macroprolactinoma.…”