Impact of menopause on outcomes in prolactinomas after dopamine agonist treatment withdrawal
Author(s)
Type
Journal Article
Abstract
Objective
Discontinuation of dopamine agonist (DA) treatment in women with prolactinoma after menopause is a potential approach; studies systematically assessing long-term outcomes are lacking. Our aim was to investigate the natural history of prolactinoma in this group.
Design/Patients
Retrospective cohort study of women with prolactinoma diagnosed before menopause and who after menopause were not on DA.
Results
Thirty women were included. Twenty-eight received DA (median duration 18 years, median age at DA withdrawal 52 years). At last assessment (median follow-up 3 years) and compared with values 6-12 months after stopping DA, Prolactin (PRL) increased in 15%, decreased but not normalized in 33% and was normal in 52%; PRL levels or visible adenoma on imaging before DA withdrawal, treatment duration and presence of macro-/microadenoma at diagnosis were not predictors of normoprolactinaemia at last review, whereas PRL values 6-12 months after stopping DA were. Adenoma regrowth was detected in 2/27 patients (7%), who showed gradual increase in PRL. Comparison with 28 women who had DA withdrawal before their menopause revealed lower risk of hyperprolactinaemia recurrence in the postmenopausal group (HR:0.316, 95% CI: 0.101-0.985, P < .05). Two women with microprolactinoma diagnosed in perimenopausal period had not been offered DA; PRL decreased (but not normalized) during observation of 1 and 8 years.
Conclusions
Prolactin normalized over time in nearly half of the women and serum PRL 6-12 months after DA withdrawal is useful predictor. Nonetheless, 7% of the patients demonstrated adenoma regrowth which, given the life expectancy postmenopause, necessitate regular monitoring of the cases with persistent hyperprolactinaemia.
Discontinuation of dopamine agonist (DA) treatment in women with prolactinoma after menopause is a potential approach; studies systematically assessing long-term outcomes are lacking. Our aim was to investigate the natural history of prolactinoma in this group.
Design/Patients
Retrospective cohort study of women with prolactinoma diagnosed before menopause and who after menopause were not on DA.
Results
Thirty women were included. Twenty-eight received DA (median duration 18 years, median age at DA withdrawal 52 years). At last assessment (median follow-up 3 years) and compared with values 6-12 months after stopping DA, Prolactin (PRL) increased in 15%, decreased but not normalized in 33% and was normal in 52%; PRL levels or visible adenoma on imaging before DA withdrawal, treatment duration and presence of macro-/microadenoma at diagnosis were not predictors of normoprolactinaemia at last review, whereas PRL values 6-12 months after stopping DA were. Adenoma regrowth was detected in 2/27 patients (7%), who showed gradual increase in PRL. Comparison with 28 women who had DA withdrawal before their menopause revealed lower risk of hyperprolactinaemia recurrence in the postmenopausal group (HR:0.316, 95% CI: 0.101-0.985, P < .05). Two women with microprolactinoma diagnosed in perimenopausal period had not been offered DA; PRL decreased (but not normalized) during observation of 1 and 8 years.
Conclusions
Prolactin normalized over time in nearly half of the women and serum PRL 6-12 months after DA withdrawal is useful predictor. Nonetheless, 7% of the patients demonstrated adenoma regrowth which, given the life expectancy postmenopause, necessitate regular monitoring of the cases with persistent hyperprolactinaemia.
Date Issued
2018-09-01
Date Acceptance
2018-06-10
Citation
Clinical Endocrinology, 2018, 89 (3), pp.346-353
ISSN
0300-0664
Publisher
Wiley
Start Page
346
End Page
353
Journal / Book Title
Clinical Endocrinology
Volume
89
Issue
3
Copyright Statement
© 2018 John Wiley & Sons Ltd.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29894000
Subjects
CABERGOLINE
dopamine agonists
Endocrinology & Metabolism
HYPERPROLACTINEMIA
Life Sciences & Biomedicine
menopause
METAANALYSIS
PITUITARY-ADENOMAS
PREVALENCE
PROFILE
prolactin
prolactinoma
RECURRENCE
Science & Technology
THERAPY
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-06-12