Document Detail


Recurrence of hyperprolactinemia after withdrawal of long-term cabergoline therapy.
MedLine Citation:
PMID:  19336508     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Recurrence of hyperprolactinemia after cabergoline withdrawal ranges widely from 36 to 80%. The Pituitary Society recommends withdrawal of cabergoline in selected patients.
OBJECTIVE: Our aim was to evaluate recurrence of hyperprolactinemia in patients meeting The Pituitary Society guidelines.
DESIGN: Patients were followed from the date of discontinuation to either relapse of hyperprolactinemia or the day of last prolactin test.
SETTING: We conducted the study at an academic medical center.
PATIENTS: Forty-six patients meeting Pituitary Society criteria (normoprolactinemic and with tumor volume reduction after 2 or more years of treatment) participated in the study.
INTERVENTIONS: After withdrawal, if prolactin returned above reference range, another measurement was obtained within 1 month, symptoms were assessed by questionnaire, and magnetic resonance imaging was performed.
MAIN OUTCOME MEASURES: We measured risk of and time to recurrence estimates as well as clinical predictors of recurrence.
RESULTS: Mean age of patients was 50 +/- 13 yr, and 70% were women. Thirty-one patients had microprolactinomas, 11 had macroprolactinomas, and four had nontumoral hyperprolactinemia. The overall recurrence was 54%, and the estimated risk of recurrence by 18 months was 63%. The median time to recurrence was 3 months (range, 1-18 months), with 91% of recurrences occurring within 1 yr after discontinuation. Size of tumor remnant prior to withdrawal predicted recurrence [18% increase in risk for each millimeter (95% confidence interval, 3-35; P = 0.017)]. None of the tumors enlarged in the patients experiencing recurrence, and 28% had symptoms of hypogonadism.
CONCLUSIONS: Cabergoline withdrawal is practical and safe in a subset of patients as defined by The Pituitary Society guidelines; however, the average risk of long-term recurrence in our study was over 60%. Close follow-up remains important, especially within the first year.
Authors:
J Kharlip; R Salvatori; G Yenokyan; G S Wand
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-03-31
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  94     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-08     Completed Date:  2009-08-06     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2428-36     Citation Subset:  AIM; IM    
Affiliation:
Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 21201, USA. jkharlip@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Antineoplastic Agents / adverse effects,  therapeutic use
Ergolines / adverse effects,  therapeutic use*
Female
Humans
Hyperprolactinemia / diagnosis,  drug therapy*,  epidemiology,  etiology
Male
Middle Aged
Pituitary Neoplasms / complications,  drug therapy,  pathology
Pregnancy
Pregnancy Complications, Neoplastic / drug therapy
Prognosis
Prolactinoma / complications,  drug therapy,  pathology
Recurrence
Retrospective Studies
Time Factors
Withholding Treatment*
Young Adult
Grant Support
ID/Acronym/Agency:
T32 DK062707/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 0/Ergolines; LL60K9J05T/cabergoline
Comments/Corrections
Comment In:
J Clin Endocrinol Metab. 2009 Jul;94(7):2247-9   [PMID:  19584197 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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