Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - Padiglione Zonda, Via F. Sforza, 35, 20122, Milan, Italy.
Horm Cancer. 2019 Jun;10(2-3):120-127. doi: 10.1007/s12672-019-00363-4. Epub 2019 Apr 18.
Natural course of prolactinomas after menopause is not fully elucidated. The aim of this study was to compare recurrence rate after cabergoline withdrawal in premenopausal vs. postmenopausal women with microprolactinoma. Sixty-two women with microprolactinoma treated with cabergoline for at least 1 year and followed for 2 years after drug withdrawal were retrospectively selected. Patients were divided into two groups: 48 patients stopped cabergoline before menopause ("PRE" group), while 14 after menopause ("POST" group). Recurrence was defined by prolactin levels above normal, confirmed on two occasions. Overall, 39/62 women relapsed. Patients who relapsed apparently had higher prolactin before withdrawal (median 216.2, range 21.2-464.3 mIU/L) compared with those in long-term remission (94.3, 29.7-402.8 mIU/L; p < 0.05), and the risk of recurrence seemed lower in POST women (4/14, 29%) than in PRE ones (35/48, 73%, p < 0.005, OR 0.149, 95% CI 0.040-0.558). However, none of the factors (prolactin before withdrawal, menopausal status, treatment duration, complete adenoma regression) showed a correlation with recurrence risk in multivariate analysis. The best strategy able to optimize CBG treatment and withdrawal's outcomes is still to be defined in microprolactinomas. Postmenopausal status cannot reliably predict long-term remission, and follow-up is needed also in women of this age.
绝经后泌乳素瘤的自然病程尚未完全阐明。本研究旨在比较绝经前和绝经后微泌乳素瘤患者停用卡麦角林后的复发率。回顾性选择了 62 例接受卡麦角林治疗至少 1 年且停药后随访 2 年的微泌乳素瘤患者。患者分为两组:48 例在绝经前停止卡麦角林(“PRE”组),14 例在绝经后停止(“POST”组)。复发定义为催乳素水平升高,两次确认。总体而言,62 例患者中有 39 例复发。明显复发的患者停药前催乳素水平较高(中位数 216.2,范围 21.2-464.3 mIU/L),与长期缓解的患者相比(94.3,29.7-402.8 mIU/L;p < 0.05),且 POST 组(4/14,29%)的复发风险低于 PRE 组(35/48,73%,p < 0.005,OR 0.149,95%CI 0.040-0.558)。然而,在多变量分析中,没有任何因素(停药前催乳素水平、绝经状态、治疗持续时间、腺瘤完全消退)与复发风险相关。在微泌乳素瘤中,仍需确定最佳的卡麦角林治疗和停药策略。绝经后状态不能可靠地预测长期缓解,即使在这个年龄段的女性也需要进行随访。