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

Abstract

BACKGROUND:

The optimal duration of cabergoline (CAB) treatment of prolactinomas that minimizes recurrences is not well established. 2011 Endocrine Society Guidelines suggested that withdrawal may be safely undertaken after 2 years in patients achieving normoprolactinemia and tumor reduction.

MATERIALS:

We analyzed 74 patients (mean age = 46.9 ± 14.4, M/F = 19/55, macro/micro = 18/56) bearing a prolactinoma divided in 3 groups: group A (23) treated for 3 years, group B (23) for a period between 3 and 5 years, and group C (28) for a period >5 years. CAB therapy was interrupted according to Endocrine Society Guidelines. Prolactin (PRL) levels were measured 3, 6, 12 and 24 months after withdrawal. Recurrence was defined with PRL levels ≥30 ng/ml.

RESULTS:

Groups did not differ in pretreatment PRL levels (123.2 ± 112.1, 120.9 ± 123.8, 176.6 ± 154.0), pituitary deficit (4, 17, 17 %), mean CAB weekly dose (0.7 ± 0.4, 0.6 ± 0.3, 0.7 ± 0.4) and PRL levels before withdrawal (17.1 ± 19.6, 11.4 ± 8.8, 13.8 ± 13.5). Recurrence occurred within 12 months in 34 patients (45.9 %), without significant differences among groups. Neuroradiological evaluation showed a significantly higher presence of macroadenoma in group C (13, 17 and 39 %, respectively). Recurrence rate of hyperprolactinemia did not depend on sex, tumor size or CAB dose but it was significantly correlated with PRL levels at diagnosis and before withdrawal (p = 0.03). Finally, patients with pituitary deficit at diagnosis showed a significantly higher recurrence rate (p = 0.03).

CONCLUSIONS:

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.

• Authors: E Sala, P Bellaviti Buttoni, E Malchiodi, E Verrua, G Carosi, E Profka, G Rodari, M Filopanti, E Ferrante, A Spada, G Mantovani
• Journal: Journal of endocrinological investigation (J Endocrinol Invest) Vol. 39 Issue 12 Pg. 1377-1382 (Dec 2016) ISSN: 1720-8386 [Electronic] Italy
• PMID: 27245604 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Dopamine Agonists
• Ergolines
• Cabergoline

Topics

• Adult
• Aged
• Biomarkers (blood)
• Cabergoline
• Dopamine Agonists (therapeutic use)
• Ergolines (therapeutic use)
• Female
• Humans
• Hyperprolactinemia (diagnosis, etiology)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (diagnosis, etiology)
• Pituitary Neoplasms (complications, drug therapy, pathology)
• Prognosis
• Prolactinoma (complications, drug therapy, pathology)
• Tomography, X-Ray Computed (methods)
• Withholding Treatment