Division of Endocrinology and Metabolism, and Pituitary Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
J Clin Endocrinol Metab. 2020 Dec 1;105(12). doi: 10.1210/clinem/dgaa652.
Withdrawal of dopamine agonist (DA) therapy in patients with prolactinoma who are controlled by a small dose of medication is recommended by several guidelines. So far, the likelihood of reaching withdrawal conditions based on baseline characteristics remains uncertain.
We retrospectively examined early clinical, radiological, or biochemical features that may predict the likelihood of reaching withdrawal conditions in prolactinoma patients. Data were obtained in a single academic medical center in the United States from patients seen between 2000 and 2018. Using multiple logistic regression, we compared patients who reached withdrawal conditions with those who did not.
Of 213 patients, 78 (36.6%) reached withdrawal conditions after at least 2 years of DA treatment. Initial maximal tumor diameter was significantly smaller in those who reached withdrawal conditions than in those who did not. Percent prolactin change at the first check from initiation of DA therapy and parasellar invasiveness were predictors of reaching withdrawal conditions. With constant independent variables, there was a 7% increase in odds for reaching withdrawal conditions for every 1% decrease in percent prolactin change at first check after DA therapy start (P = 0.0000). Parasellar invasion decreased the odds of reaching withdrawal conditions by 84% (P = 0.0000).
DA remains a potential life-long treatment modality for most prolactinoma patients. Patients with parasellar invasiveness and low prolactin percent change from baseline to first prolactin check are more likely to require long-term treatment.
几项指南都建议，对于因接受小剂量药物治疗而得到控制的泌乳素瘤患者，应停止使用多巴胺激动剂（DA）治疗。但到目前为止，基于基线特征，达到停药条件的可能性仍不确定。
我们回顾性地检查了可能预测泌乳素瘤患者达到停药条件的早期临床、放射影像学或生化特征。数据来自美国一家学术医疗中心 2000 年至 2018 年间就诊的患者。我们使用多因素逻辑回归比较了达到停药条件的患者和未达到停药条件的患者。
在 213 例患者中，78 例（36.6%）在接受 DA 治疗至少 2 年后达到停药条件。达到停药条件的患者初始最大肿瘤直径明显小于未达到停药条件的患者。DA 治疗起始后首次检查时的泌乳素变化百分比和蝶鞍旁侵袭性是达到停药条件的预测因素。在恒定的独立变量下，DA 治疗后首次检查时的泌乳素变化百分比每降低 1%，达到停药条件的几率就会增加 7%（P<0.0000）。蝶鞍旁侵袭性使达到停药条件的几率降低了 84%（P<0.0000）。
DA 仍然是大多数泌乳素瘤患者的潜在终身治疗方法。具有蝶鞍旁侵袭性和从基线到首次泌乳素检查时泌乳素百分比变化低的患者更可能需要长期治疗。
