Dopamine agonist withdrawal in patients with prolactinoma

Dopamine agonists (DA) are an effective first-line treatment for prolactinomas, achieving high rates of prolactin normalization, gonadal recovery and tumor shrinkage. However, chronic DA therapy also has many downsides, including common short-term side effects such as nausea and dizziness, the risk of impulse control or emotional disorders, and the need for cardiac valvular monitoring at high doses. This duality of beneficial and adverse DA effects has led clinicians to more frequently attempt treatment reduction and withdrawal. In this review, we will summarize the evidence and determine the most appropriate DA withdrawal strategies in premenopausal and post-menopausal women, in men, and in children and adolescents. We will discuss surveillance protocols after withdrawal and therapeutic strategies in case of recurrence. In order to understand why remission remains unachievable in most patients, future research must elucidate the underlying cellular pathways governing the biological and radiological response to DA.