title: Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis.
abstract: BACKGROUND
  Dopamine agonists are the treatment of choice for prolactinomas and symptomatic idiopathic hyperprolactinemia. However, the optimal treatment strategy and treatment duration is not clear in all details.
  
  
  OBJECTIVE
  The aim of the study was to assess the effect of dopamine agonist withdrawal in patients with idiopathic hyperprolactinemia and prolactinomas.
  
  
  METHODS
  PubMed, the Cochrane Library, the Web of Science, and EMBASE were searched electronically. No restriction was made with respect to language.
  
  
  METHODS
  Studies reporting the proportion of normoprolactinemic patients after withdrawal of dopamine agonist or studies in which this proportion could be calculated were eligible. Both observational studies and clinical trials were eligible. Nineteen studies were included in the meta-analysis, with a total of 743 patients.
  
  
  METHODS
  Data extraction was performed by two reviewers independently.
  
  
  RESULTS
  The pooled proportion of patients with persisting normoprolactinemia after dopamine agonist withdrawal was 21% in a random effects model [95% confidence interval (CI), 14-30%; I(2) 81%). Stratified analysis showed higher proportions of treatment success in idiopathic hyperprolactinemia (32%; 95% CI, 5-80%), compared with both microprolactinomas (21%; 95% CI, 10-37%), and macroprolactinomas (16%; 95% CI, 6-36%). In a random effects meta-regression adjusting for cause of hyperprolactinemia, a longer treatment duration was associated with treatment success (P = 0.015), whereas the use of cabergoline showed a trend of effect (P = 0.07).
  
  
  CONCLUSIONS
  This meta-analysis showed that hyperprolactinemia will recur after dopamine agonist withdrawal in a considerable proportion of patients. The probability of treatment success was highest when cabergoline was used for at least 2 yr.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, C4-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. o.m.dekkers@lumc.nl
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: Joep
authors.initials: J
authors.lastname: Lagro
authors.forename: Pia
authors.initials: P
authors.lastname: Burman
authors.forename: Jens Otto
authors.initials: JO
authors.lastname: Jørgensen
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
mesh_terms: D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications / Q000188:drug therapy*; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy; D015175:Prolactinoma / Q000150:complications / Q000188:drug therapy; D012008:Recurrence; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D018491:Dopamine Agonists