Predictors of remission of hyperprolactinaemia after long‐term withdrawal of cabergoline therapy
- 20 July 2007
- journal article
- Published by Wiley in Clinical Endocrinology
- Vol. 67 (3), 426-433
- https://doi.org/10.1111/j.1365-2265.2007.02905.x
Abstract
Background Remission rates of 76, 69·5 and 64·3% have been reported in patients with nontumoural hyperprolactinaemia (NTH), microprolactinoma and macroprolactinoma, respectively, 2–5 years after cabergoline (CAB) withdrawal. Objective To report the estimated recurrence rate at 24–96 months after CAB withdrawal and indicate predictors of disease remission. Design Observational, analytical, prospective. Patients Of 381 previously untreated de novo patients with hyperprolactinaemia, 221 (58%) (173 women, 48 men; 27 with NTH, 115 with micro‐, and 79 with macroprolactinoma) were studied. Measurements Using multiple regression analysis the diagnostic accuracy of nadir PRL levels (t = 7·6, P < 0·0001) and nadir maximal tumour diameter at CAB withdrawal (t = 3·9, P < 0·001) was analysed using receiver operating characteristic (ROC) curves. Results The recurrence of hyperprolactinaemia was 25·9, 33·9 and 53·1% in patients with NTH, micro‐ or macroprolactinoma, respectively. To predict the last PRL level after withdrawal, the optimum cut‐off of nadir PRL levels at withdrawal was 162 mU/l (5·4 µg/l) [sensitivity (95% CI) 76% (67–84%), specificity 65% (51–77%)] and that of nadir maximal tumour diameter was 3·1 mm [sensitivity 52% (41–63%), specificity 86% (79–91%)]. The patients achieving both nadir PRL levels ≤ 162 mU/l and maximal tumour diameter ≤ 3·1 mm (n = 111) at CAB withdrawal had a significantly lower Kaplan–Meier estimate of recurrence of hyperprolactinaemia (20%) at 24–96 months than those who did not fulfil any of these criteria [(n = 38) 90%; P < 0·0001]. Patients achieving nadir PRL levels ≤ 162 mU/l (n = 26) or maximal tumour diameter ≤ 3·1 mm during CAB treatment (n = 46) had an estimated recurrence rate of hyperprolactinaemia of 50 and 56%, respectively. Conclusion Persistent remission of hyperprolactinaemia without any evidence of tumour re‐growth after 24–96 months of CAB withdrawal occurred in the majority of patients with NTH and microprolactinoma and in about half of those with macroprolactinoma. Nadir PRL levels and maximal tumour diameter at CAB withdrawal of ≤ 162 mU/l and ≤ 3·1 mm predicted remission of hyperprolactinaemia in 80% of patients.Keywords
This publication has 42 references indexed in Scilit:
- The treatment with cabergoline for 24 month normalizes the quality of seminal fluid in hyperprolactinaemic malesClinical Endocrinology, 2006
- Long‐term remission following withdrawal of dopamine agonist therapy in subjects with microprolactinomasClinical Endocrinology, 2005
- Long-Term Follow-Up of Prolactinomas: Normoprolactinemia after Bromocriptine WithdrawalJournal of Clinical Endocrinology & Metabolism, 2002
- Surgical Treatment of Prolactin-Secreting Pituitary Adenomas: Early Results and Long-Term OutcomeJournal of Clinical Endocrinology & Metabolism, 2002
- Resistance to Cabergoline as Compared with Bromocriptine in Hyperprolactinemia: Prevalence, Clinical Definition, and Therapeutic StrategyJournal of Clinical Endocrinology & Metabolism, 2001
- Long-Term and Low-Dose Treatment with Cabergoline Induces Macroprolactinoma ShrinkageJournal of Clinical Endocrinology & Metabolism, 1997
- Prolactinomas Resistant to Standard Dopamine Agonists Respond to Chronic Cabergoline TreatmentJournal of Clinical Endocrinology & Metabolism, 1997
- Treatment of prolactin-secreting macroadenomas with the once-weekly dopamine agonist cabergolineJournal of Clinical Endocrinology & Metabolism, 1996
- FACTORS IN THE OUTCOME OF TRANSSPHENOIDAL SURGERY FOR PROLACTINOMA AND NON‐FUNCTIONING PITUITARY TUMOUR, INCLUDING PREOPERATIVE BROMOCRIPTINE THERAPYClinical Endocrinology, 1987
- MENSTRUAL FUNCTION AND SERUM PROLACTIN LEVELS AFTER LONG-TERM BROMOCRIPTINE TREATMENT OF HYPERPROLACTINAEMIC AMENORRHOEAClinical Endocrinology, 1982