Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar S. João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
Pituitary. 2017 Aug;20(4):464-470. doi: 10.1007/s11102-017-0806-x.
Prolactinomas are the most common functional pituitary tumour. Dopamine agonists (DA) are its principal treatment. The criteria that should guide therapy withdrawal and the factors that influence disease remission or relapse are not yet fully established. Our purpose is to evaluate the proportion of patients who attempted DA withdrawal, and to identify the factors that influence clinicians to try it. In addition, we aim to study the factors that are involved in prolactinoma remission/relapse after therapy withdrawal.
We retrospectively evaluated 142 patients with prolactinoma diagnosis who had been treated exclusively with DA. Firstly, the patients were divided in two groups, according to whether DA withdrawal had been attempted, or not, and the factors that might predict clinicians' decision to discontinue the therapy were then analysed. Secondly, patients who attempted withdrawal were further divided into two subgroups, based on their remission or relapse status and predictors of remission were evaluated.
DA withdrawal was attempted in 35.2% of our patients. Females, subjects with lower initial serum prolactin (PRL) levels, those with microadenomas and those with longer treatment duration all had a higher probability of seeing their therapy discontinued. In the withdrawal group, the remission rate was 72%. Macroprolactinomas relapse more often than microprolactinomas (p < 0.05). The recurrence group had higher median initial serum PRL levels and a lower mean duration of therapy, however these variables did not reach statistical significance.
We found a low percentage of attempt of withdrawal of DA therapy in the subjects with prolactinoma. Our data confirms that DA therapy can be discontinued with a high remission rate. Tumour size was the main variable that affected the withdrawal outcome in our patients.
催乳素瘤是最常见的功能性垂体瘤。多巴胺激动剂（DA）是其主要治疗方法。指导停药的标准和影响疾病缓解或复发的因素尚未完全确定。我们的目的是评估尝试 DA 停药的患者比例，并确定影响临床医生尝试的因素。此外，我们旨在研究治疗停药后催乳素瘤缓解/复发的相关因素。
我们回顾性评估了 142 例仅接受 DA 治疗的催乳素瘤患者。首先，根据是否尝试 DA 停药将患者分为两组，并分析可能预测临床医生停止治疗的因素。其次，对尝试停药的患者根据其缓解或复发情况进一步分为两组，并评估缓解的预测因素。
我们的患者中有 35.2%尝试了 DA 停药。女性、初始血清催乳素（PRL）水平较低、微腺瘤和治疗时间较长的患者更有可能停止治疗。在停药组中，缓解率为 72%。大腺瘤比微腺瘤更易复发（p<0.05）。复发组的初始血清 PRL 水平中位数较高，治疗持续时间较短，但这些变量没有达到统计学意义。
我们发现催乳素瘤患者尝试 DA 停药的比例较低。我们的数据证实，DA 治疗可以停药，缓解率较高。肿瘤大小是影响我们患者停药结果的主要变量。
