Dogansen Sema Ciftci, Selcukbiricik Ozlem Soyluk, Tanrikulu Seher, Yarman Sema
Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Capa, 34090, Istanbul, Turkey.
Pituitary. 2016 Jun;19(3):303-10. doi: 10.1007/s11102-016-0708-3.
The aim of the study was to assess the effect of dopamine agonist (DA) withdrawal, the current recurrence rate of hyperprolactinemia, and possible factors that predict recurrence in patients with prolactinoma.
We evaluated DA withdrawal in 67 patients with prolactinoma (50 female/17 male) who received DA treatment for at least 2 years and showed normalization of prolactin (PRL) levels and tumor disappearance or ≥50 % tumor shrinkage, retrospectively. Accordingly, patients were divided into two groups as remission and recurrence groups, and factors that predict recurrence were evaluated.
The overall remission rate was 46 %; the remission ratios were 65 % in microprolactinomas and 36 % in macroprolactinomas. Remission rates were 39 % in the bromocriptine withdrawal group and 55 % in the cabergoline withdrawal group. The maximum tumor diameter and baseline PRL levels were significantly higher in the recurrence group (p = 0.001 and p = 0.003, respectively). The mean duration of DA therapy was significantly longer in the remission group (88.7 ± 48.1 and 66.7 ± 30.4 months, respectively, p = 0.026).The mean time to recurrence was 5.3 ± 3.2 months. The mean PRL levels at recurrence time were significantly lower than baseline PRL levels (p = 0.001).
The most important predictors of recurrence were maximum tumor diameter and baseline PRL levels in this study. The remission rate in our study group was higher, which was thought to be associated with the longer duration of DA treatment and that our patients were selected according to certain criteria. Despite these positive results, close monitoring is necessary for detection of early and late recurrence, especially within the first year after DA withdrawal.
本研究旨在评估多巴胺激动剂（DA）撤药的效果、目前高泌乳素血症的复发率以及预测泌乳素瘤患者复发的可能因素。
我们回顾性评估了67例接受DA治疗至少2年且泌乳素（PRL）水平恢复正常、肿瘤消失或缩小≥50%的泌乳素瘤患者（50例女性/17例男性）的DA撤药情况。据此，将患者分为缓解组和复发组，并评估预测复发的因素。
总体缓解率为46%；微泌乳素瘤的缓解率为65%，大泌乳素瘤的缓解率为36%。溴隐亭撤药组的缓解率为39%，卡麦角林撤药组的缓解率为55%。复发组的最大肿瘤直径和基线PRL水平显著更高（分别为p = 0.001和p = 0.003）。缓解组的DA治疗平均持续时间显著更长（分别为88.7±48.1个月和66.7±30.4个月，p = 0.026）。复发的平均时间为5.3±3.2个月。复发时的平均PRL水平显著低于基线PRL水平（p = 0.001）。
本研究中复发的最重要预测因素是最大肿瘤直径和基线PRL水平。我们研究组的缓解率更高，这被认为与DA治疗持续时间更长以及我们的患者是根据特定标准选择有关。尽管有这些积极结果，但仍需要密切监测以检测早期和晚期复发，尤其是在DA撤药后的第一年内。
