Recurrence of hyperprolactinemia after withdrawal of long-term cabergoline therapy.
J Clin Endocrinol Metab
; 94(7): 2428-36, 2009 Jul.
Article
in En
| MEDLINE
| ID: mdl-19336508
ABSTRACT
CONTEXT Recurrence of hyperprolactinemia after cabergoline withdrawal ranges widely from 36 to 80%. The Pituitary Society recommends withdrawal of cabergoline in selected patients. OBJECTIVE:
Our aim was to evaluate recurrence of hyperprolactinemia in patients meeting The Pituitary Society guidelines.DESIGN:
Patients were followed from the date of discontinuation to either relapse of hyperprolactinemia or the day of last prolactin test.SETTING:
We conducted the study at an academic medical center. PATIENTS Forty-six patients meeting Pituitary Society criteria (normoprolactinemic and with tumor volume reduction after 2 or more years of treatment) participated in the study.INTERVENTIONS:
After withdrawal, if prolactin returned above reference range, another measurement was obtained within 1 month, symptoms were assessed by questionnaire, and magnetic resonance imaging was performed. MAIN OUTCOMEMEASURES:
We measured risk of and time to recurrence estimates as well as clinical predictors of recurrence.RESULTS:
Mean age of patients was 50 +/- 13 yr, and 70% were women. Thirty-one patients had microprolactinomas, 11 had macroprolactinomas, and four had nontumoral hyperprolactinemia. The overall recurrence was 54%, and the estimated risk of recurrence by 18 months was 63%. The median time to recurrence was 3 months (range, 1-18 months), with 91% of recurrences occurring within 1 yr after discontinuation. Size of tumor remnant prior to withdrawal predicted recurrence [18% increase in risk for each millimeter (95% confidence interval, 3-35; P = 0.017)]. None of the tumors enlarged in the patients experiencing recurrence, and 28% had symptoms of hypogonadism.CONCLUSIONS:
Cabergoline withdrawal is practical and safe in a subset of patients as defined by The Pituitary Society guidelines; however, the average risk of long-term recurrence in our study was over 60%. Close follow-up remains important, especially within the first year.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hyperprolactinemia
/
Withholding Treatment
/
Ergolines
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Evaluation_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
/
Pregnancy
Language:
En
Journal:
J Clin Endocrinol Metab
Year:
2009
Document type:
Article
Affiliation country:
Estados Unidos