Long-term follow-up of prolactinomas: should dopamine agonist treatment be life-long?

Dopamine agonists (DA) are the treatment of choice for both micro- and macroadenomas. However, the only limitation of this treatment is the low rate of cure, as well as the long-term therapy usually seen in most patients. In our data, 16% of patients with prolactinomas remained normoprolactinemic after DA withdrawal. The duration of treatment before DA discontinuation was the only statistically significant factor in the cured versus the remission groups. Taking into account all the data from the published series, the rate of cure after DA withdrawal ranged from 5 to 37.5%, and only 1% of tumor regrowth was observed in spite of the high recurrence rate. The board of experts provided recommendations based on the revision of all the data presented at this consensus meeting: dopamine agonists can be routinely withdrawn in patients receiving DA. The length of treatment recommended is 1-3 years, during which DA may be tapered off, and serum PRL levels should be monitored. Tumor disappearance on MRI and the levels of PRL under the lower dose of DA will be determinant for DA withdrawal. Factors influencing prolactinomas outcome are analyzed in the discussion.