Management of prolactinomas in Brazil: an electronic survey.
Dopamine agonists are the treatment of choice for prolactinomas. However, there are still controversies concerning dose, treatment duration and criteria for drug withdrawal in different clinical situations. The aim of this study was to assess diagnostic and therapeutic approaches to prolactinomas among members of the Brazilian Society of Endocrinology and Metabolism (SBEM). SBEM members answered a questionnaire sent by e-mail that included 18 questions related to controversial issues about the management of prolactinomas. Among SBEM members, 721 (approximately 24% of total) answered the questionnaire. Concerning the diagnosis, 38% of the respondents stated that prolactin levels < 100 ng/ml would exclude the presence of a prolactinoma. Most of them favored the screening for macroprolactin in asymptomatic individuals instead of a routine screening (74% vs. 26%). Regarding the treatment, 70% of the respondents chose cabergoline as the drug of choice to treat macroprolactinomas whereas similar proportions advised cabergoline or bromocriptine as the best treatment for microprolactinomas (52% vs. 48%). Only 20% and 34% of respondents favored treatment withdrawal 2-3 years after prolactin normalization in patients with macroprolactinomas and microprolactinomas, respectively. In case of pregnancy, only 58 and 70% of respondents advocated discontinuation of treatment with dopamine agonists in patients with macroprolactinomas and microprolactinomas, respectively. Finally, only 36% would allow breast-feeding without restriction, 44% would restrict it to patients with microprolactinomas and 20% would not recommend it for women with prolactinomas There are several points of disagreement among SBEM members regarding the management of prolactinomas.
Vilar
Lucio
L
Division of Endocrinology, Hospital das Clinicas, Pernambuco Federal University, Rua Clovis Silveira Barros, 84/1202, Boa Vista, Recife, PE, CEP 50.050-270, Brazil. lvilar@gmail.com
Naves
Luciana Ansaneli
LA
Casulari
Luiz Augusto
LA
Azevedo
Monalisa Ferreira
MF
Albuquerque
José Luciano
JL
Serfaty
Fabiano Marcel
FM
Pinho Barbosa
Flavia R
FR
de Oliveira
Antonio Ribeiro
AR
Montenegro
Renan Magalhães
RM
Montenegro
Renan Magalhães
RM
Ramos
Alberto José Santos
AJ
Dos Santos Faria
Manuel
M
Musolino
Nina Rosa C
NR
Gadelha
Monica R
MR
Boguszewski
Cesar Luiz
CL
Bronstein
Marcello D
MD
D001938:Brazil; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D003625:Data Collection; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D011247:Pregnancy; D015175:Prolactinoma / Q000188:drug therapy*
D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; D000077465:Cabergoline