Factors determining the remission of microprolactinomas after dopamine agonist withdrawal

M. S. B. Huda; N. B. Athauda; M. M. Teh; P. V. Carroll; J. K. Powrie

doi:10.1111/j.1365-2265.2009.03657.x

Factors determining the remission of microprolactinomas after dopamine agonist withdrawal

M. S. B. Huda, N. B. Athauda, M. M. Teh, P. V. Carroll, J. K. Powrie^*

^*Corresponding author for this work

GSTT Guy's and St Thomas' NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

40 Citations (Scopus)

Abstract

Background

Withdrawal of dopamine agonist (DA) therapy in the management of microprolactinoma is common practice, but it is unclear which patients are likely to attain long-term remission.

Objective

To identify predictive factors for long-term remission.

Design

Prospective cohort study.

Patients

Forty subjects (39 female, aged 24-60 years) with microprolactinoma; all had been normoprolactinaemic on DA therapy for at least 2 years [mean duration of therapy 9 years (range 2-27)].

Measurements

A pituitary magnetic resonance imaging (MRI) was performed on 36 (90%) subjects before DA withdrawal. Relapse was defined as prolactin greater than 480 mIU/l (22 center dot 8 mu g/l) on two occasions.

Results

Nine out of 40 (22 center dot 5%) subjects were normoprolactinaemic 12 months after DA withdrawal. Amongst the relapse group, 24 of 31 subjects (79 center dot 4%) had already relapsed at 3 months. Normalization of MRI prior to DA withdrawal (P = 0 center dot 0006) and longer duration of DA treatment (P = 0 center dot 032) were significant predictors of remission. Age, pre-treatment prolactin, nadir prolactin, previous failure of DA withdrawal, pregnancy, dose and type of DA were not significant predictors of remission. The nine patients who were in remission at 12 months were then followed up for 58 center dot 0 +/- 5 center dot 8 months; all remained in remission.

Conclusions

As many as 22 center dot 5% of subjects with microprolactinoma remained normoprolactinaemic 12 months after DA withdrawal and these subjects stayed in remission for up to 5 years. Significant predictive factors were normalization of MRI prior to discontinuation, and duration of DA treatment. Our findings support intermittent DA withdrawal after a period of normoprolactinaemia, particularly where MRI appearances have normalized.

Original language	English
Pages (from-to)	507-511
Number of pages	5
Journal	Clinical endocrinology
Volume	72
Issue number	4
DOIs	https://doi.org/10.1111/j.1365-2265.2009.03657.x
Publication status	Published - Apr 2010

Keywords

LONG-TERM THERAPY
BROMOCRIPTINE TREATMENT
CABERGOLINE THERAPY
DRUG-WITHDRAWAL
NATURAL-HISTORY
FOLLOW-UP
PROLACTINOMAS
HYPERPROLACTINEMIA
GUIDELINES
MANAGEMENT

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10.1111/j.1365-2265.2009.03657.x

Cite this

@article{73329de3ee2942d8b89bd58f6dc45421,

title = "Factors determining the remission of microprolactinomas after dopamine agonist withdrawal",

abstract = "BackgroundWithdrawal of dopamine agonist (DA) therapy in the management of microprolactinoma is common practice, but it is unclear which patients are likely to attain long-term remission.ObjectiveTo identify predictive factors for long-term remission.DesignProspective cohort study.PatientsForty subjects (39 female, aged 24-60 years) with microprolactinoma; all had been normoprolactinaemic on DA therapy for at least 2 years [mean duration of therapy 9 years (range 2-27)].MeasurementsA pituitary magnetic resonance imaging (MRI) was performed on 36 (90%) subjects before DA withdrawal. Relapse was defined as prolactin greater than 480 mIU/l (22 center dot 8 mu g/l) on two occasions.ResultsNine out of 40 (22 center dot 5%) subjects were normoprolactinaemic 12 months after DA withdrawal. Amongst the relapse group, 24 of 31 subjects (79 center dot 4%) had already relapsed at 3 months. Normalization of MRI prior to DA withdrawal (P = 0 center dot 0006) and longer duration of DA treatment (P = 0 center dot 032) were significant predictors of remission. Age, pre-treatment prolactin, nadir prolactin, previous failure of DA withdrawal, pregnancy, dose and type of DA were not significant predictors of remission. The nine patients who were in remission at 12 months were then followed up for 58 center dot 0 +/- 5 center dot 8 months; all remained in remission.ConclusionsAs many as 22 center dot 5% of subjects with microprolactinoma remained normoprolactinaemic 12 months after DA withdrawal and these subjects stayed in remission for up to 5 years. Significant predictive factors were normalization of MRI prior to discontinuation, and duration of DA treatment. Our findings support intermittent DA withdrawal after a period of normoprolactinaemia, particularly where MRI appearances have normalized.",

keywords = "LONG-TERM THERAPY, BROMOCRIPTINE TREATMENT, CABERGOLINE THERAPY, DRUG-WITHDRAWAL, NATURAL-HISTORY, FOLLOW-UP, PROLACTINOMAS, HYPERPROLACTINEMIA, GUIDELINES, MANAGEMENT",

author = "Huda, {M. S. B.} and Athauda, {N. B.} and Teh, {M. M.} and Carroll, {P. V.} and Powrie, {J. K.}",

year = "2010",

month = apr,

doi = "10.1111/j.1365-2265.2009.03657.x",

language = "English",

volume = "72",

pages = "507--511",

journal = "Clinical endocrinology",

issn = "0300-0664",

publisher = "Wiley-Blackwell",

number = "4",

}

TY - JOUR

T1 - Factors determining the remission of microprolactinomas after dopamine agonist withdrawal

AU - Huda, M. S. B.

AU - Athauda, N. B.

AU - Teh, M. M.

AU - Carroll, P. V.

AU - Powrie, J. K.

PY - 2010/4

Y1 - 2010/4

N2 - BackgroundWithdrawal of dopamine agonist (DA) therapy in the management of microprolactinoma is common practice, but it is unclear which patients are likely to attain long-term remission.ObjectiveTo identify predictive factors for long-term remission.DesignProspective cohort study.PatientsForty subjects (39 female, aged 24-60 years) with microprolactinoma; all had been normoprolactinaemic on DA therapy for at least 2 years [mean duration of therapy 9 years (range 2-27)].MeasurementsA pituitary magnetic resonance imaging (MRI) was performed on 36 (90%) subjects before DA withdrawal. Relapse was defined as prolactin greater than 480 mIU/l (22 center dot 8 mu g/l) on two occasions.ResultsNine out of 40 (22 center dot 5%) subjects were normoprolactinaemic 12 months after DA withdrawal. Amongst the relapse group, 24 of 31 subjects (79 center dot 4%) had already relapsed at 3 months. Normalization of MRI prior to DA withdrawal (P = 0 center dot 0006) and longer duration of DA treatment (P = 0 center dot 032) were significant predictors of remission. Age, pre-treatment prolactin, nadir prolactin, previous failure of DA withdrawal, pregnancy, dose and type of DA were not significant predictors of remission. The nine patients who were in remission at 12 months were then followed up for 58 center dot 0 +/- 5 center dot 8 months; all remained in remission.ConclusionsAs many as 22 center dot 5% of subjects with microprolactinoma remained normoprolactinaemic 12 months after DA withdrawal and these subjects stayed in remission for up to 5 years. Significant predictive factors were normalization of MRI prior to discontinuation, and duration of DA treatment. Our findings support intermittent DA withdrawal after a period of normoprolactinaemia, particularly where MRI appearances have normalized.

AB - BackgroundWithdrawal of dopamine agonist (DA) therapy in the management of microprolactinoma is common practice, but it is unclear which patients are likely to attain long-term remission.ObjectiveTo identify predictive factors for long-term remission.DesignProspective cohort study.PatientsForty subjects (39 female, aged 24-60 years) with microprolactinoma; all had been normoprolactinaemic on DA therapy for at least 2 years [mean duration of therapy 9 years (range 2-27)].MeasurementsA pituitary magnetic resonance imaging (MRI) was performed on 36 (90%) subjects before DA withdrawal. Relapse was defined as prolactin greater than 480 mIU/l (22 center dot 8 mu g/l) on two occasions.ResultsNine out of 40 (22 center dot 5%) subjects were normoprolactinaemic 12 months after DA withdrawal. Amongst the relapse group, 24 of 31 subjects (79 center dot 4%) had already relapsed at 3 months. Normalization of MRI prior to DA withdrawal (P = 0 center dot 0006) and longer duration of DA treatment (P = 0 center dot 032) were significant predictors of remission. Age, pre-treatment prolactin, nadir prolactin, previous failure of DA withdrawal, pregnancy, dose and type of DA were not significant predictors of remission. The nine patients who were in remission at 12 months were then followed up for 58 center dot 0 +/- 5 center dot 8 months; all remained in remission.ConclusionsAs many as 22 center dot 5% of subjects with microprolactinoma remained normoprolactinaemic 12 months after DA withdrawal and these subjects stayed in remission for up to 5 years. Significant predictive factors were normalization of MRI prior to discontinuation, and duration of DA treatment. Our findings support intermittent DA withdrawal after a period of normoprolactinaemia, particularly where MRI appearances have normalized.

KW - LONG-TERM THERAPY

KW - BROMOCRIPTINE TREATMENT

KW - CABERGOLINE THERAPY

KW - DRUG-WITHDRAWAL

KW - NATURAL-HISTORY

KW - FOLLOW-UP

KW - PROLACTINOMAS

KW - HYPERPROLACTINEMIA

KW - GUIDELINES

KW - MANAGEMENT

U2 - 10.1111/j.1365-2265.2009.03657.x

DO - 10.1111/j.1365-2265.2009.03657.x

M3 - Article

SN - 0300-0664

VL - 72

SP - 507

EP - 511

JO - Clinical endocrinology

JF - Clinical endocrinology

IS - 4

ER -

Factors determining the remission of microprolactinomas after dopamine agonist withdrawal

Abstract

Keywords

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