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Dopamine agonists in prolactinomas: when to withdraw?

Pedro Souteiro1,2,3, Sandra Belo4, Davide Carvalho4,5,6

  • 1Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. pedrobsouteiro@gmail.com.

Pituitary
|September 27, 2019
PubMed
Summary

Dopamine agonists (DAs) can be withdrawn in select prolactinoma patients, with higher remission rates achieved by carefully selecting candidates and optimizing treatment before attempting cessation.

Keywords:
Dopamine agonistsPituitary glandProlactinProlactinoma

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Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacology

Background:

  • Dopamine agonists (DAs) are the primary treatment for prolactinomas, effectively reducing tumor size and normalizing prolactin levels.
  • Historically, DAs were considered lifelong therapy, but studies suggest withdrawal is possible for some patients.

Purpose of the Study:

  • To evaluate the optimal timing and patient selection criteria for dopamine agonist withdrawal in prolactinoma treatment.
  • To identify predictors of successful sustained remission after drug cessation.

Main Methods:

  • Review of studies on dopamine agonist withdrawal for prolactinomas, including meta-analyses.
  • Analysis of remission rates based on tumor size, drug used, and treatment duration.
  • Identification of patient characteristics and treatment parameters associated with successful withdrawal.

Main Results:

  • Remission rates after withdrawal vary (15-41%), influenced by tumor size and medication (bromocriptine vs. cabergoline).
  • Applying stringent criteria (e.g., >24 months treatment, normalized prolactin, >50% tumor reduction, low maintenance dose) increases sustained remission to over 50%.
  • Post-pregnancy/breastfeeding and menopause are identified as potential times to reassess DA therapy needs.

Conclusions:

  • Dopamine agonist withdrawal is feasible in a subset of prolactinoma patients, particularly with careful selection and optimized treatment.
  • Predictors of success include extended treatment duration, significant tumor shrinkage, and achieved normoprolactinemia.
  • Further prospective studies are needed to optimize DA withdrawal strategies and improve sustained remission rates.