| Abstract | OBJECTIVE: Reports suggest that up to 70% of patients with microprolactinomas treated with dopamine agonist therapy may achieve long-term normoprolactinaemic remission following drug withdrawal. Yet, there is no consensus on the duration of therapy nor is therapeutic interruption universally practised. We have assessed remission rates in a large cohort of treatment-naive subjects with microprolactinomas. Subjects received dopamine agonist (DA) therapy with either cabergoline or bromocriptine for a period of 2 to 3 years in the majority of cases, followed by a trial of treatment withdrawal. DESIGN: Retrospective analysis of clinic records of 89 patients (mean age 32.7 +/- 8.4 years, 84 women and 5 men) who had received either cabergoline (n = 67) (0.5-3 mg weekly) or bromocriptine (n = 22) (2.5-10 mg daily) for a mean duration of 3.1 years. RESULTS: Following withdrawal of therapy, 57 subjects developed recurrence (64%) and the mean time to recurrence was 9.6 months (range 1-44 months), while 32 subjects (36%) remained in remission beyond 1 year (mean 3.6 years, range 1-7 years). There was no difference in remission rates between subjects treated with cabergoline (n = 21) and bromocriptine (n = 11), but a direct relationship between pretreatment prolactin concentration and risk of recurrent symptomatic hyperprolactinaemia was observed. No subjects developed clinical features to suggest tumour expansion following therapeutic discontinuation. CONCLUSIONS: This study confirms that abrupt withdrawal of chronic dopamine agonist therapy, following 2 to 3 years of treatment is safe and associated with long-term remission in 30-40% of subjects with microprolactinomas. This therapeutic strategy is convenient and applicable in clinical practice. |
| Authors | M Biswas, J Smith, D Jadon, P McEwan, D A Rees, L M Evans, M F Scanlon, J S Davies
(Affiliation: Department of Endocrinology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK.)
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| Journal | Clinical endocrinology
(Clin Endocrinol (Oxf))
Vol. 63
Issue 1
Pg. 26-31
(Jul 2005)
ISSN: 0300-0664 England |
| PMID | 15963057
(Publication Type: Journal Article)
|
| Chemical References |
- Antineoplastic Agents
- Dopamine Agonists
- Ergolines
- Bromocriptine
- cabergoline
|
| Topics |
- Adolescent
- Adult
- Antineoplastic Agents
(therapeutic use)
- Bromocriptine
(therapeutic use)
- Dopamine Agonists
(therapeutic use)
- Ergolines
(therapeutic use)
- Female
- Humans
- Male
- Middle Aged
- Pituitary Neoplasms
(drug therapy)
- Prolactinoma
(drug therapy)
- Recurrence
- Remission Induction
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
|
