title: Treatment of hyperprolactinemia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Hyperprolactinemia is a common endocrine disorder that can be associated with significant morbidity. We conducted a systematic review and meta-analyses of outcomes of hyperprolactinemic patients, including microadenomas and macroadenomas, to provide evidence-based recommendations for practitioners. Through this review, we aimed to compare efficacy and adverse effects of medications, surgery and radiotherapy in the treatment of hyperprolactinemia.
  
  
  METHODS
  We searched electronic databases, reviewed bibliographies of included articles, and contacted experts in the field. Eligible studies provided longitudinal follow-up of patients with hyperprolactinemia and evaluated outcomes of interest. We collected descriptive, quality and outcome data (tumor growth, visual field defects, infertility, sexual dysfunction, amenorrhea/oligomenorrhea and prolactin levels).
  
  
  RESULTS
  After review, 8 randomized and 178 nonrandomized studies (over 3,000 patients) met inclusion criteria. Compared to no treatment, dopamine agonists significantly reduced prolactin level (weighted mean difference, -45; 95% confidence interval, -77 to -11) and the likelihood of persistent hyperprolactinemia (relative risk, 0.90; 95% confidence interval, 0.81 to 0.99). Cabergoline was more effective than bromocriptine in reducing persistent hyperprolactinemia, amenorrhea/oligomenorrhea, and galactorrhea. A large body of noncomparative literature showed dopamine agonists improved other patient-important outcomes. Low-to-moderate quality evidence supports improved outcomes with surgery and radiotherapy compared to no treatment in patients who were resistant to or intolerant of dopamine agonists.
  
  
  CONCLUSIONS
  Our results provide evidence to support the use of dopamine agonists in reducing prolactin levels and persistent hyperprolactinemia, with cabergoline proving more efficacious than bromocriptine. Radiotherapy and surgery are useful in patients with resistance or intolerance to dopamine agonists.
authors: Knowledge and Evaluation Research Unit and Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. wang.amy@mayo.edu
authors: Amy T
authors: AT
authors: Wang
authors: Rebecca J
authors: RJ
authors: Mullan
authors: Melanie A
authors: MA
authors: Lane
authors: Ahmad
authors: A
authors: Hazem
authors: Chaithra
authors: C
authors: Prasad
authors: Nicola W
authors: NW
authors: Gathaiya
authors: M Mercè
authors: MM
authors: Fernández-Balsells
authors: Amy
authors: A
authors: Bagatto
authors: Fernando
authors: F
authors: Coto-Yglesias
authors: Jantey
authors: J
authors: Carey
authors: Tarig A
authors: TA
authors: Elraiyah
authors: Patricia J
authors: PJ
authors: Erwin
authors: Gunjan Y
authors: GY
authors: Gandhi
authors: Victor M
authors: VM
authors: Montori
authors: Mohammad Hassan
authors: MH
authors: Murad
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D006966:Hyperprolactinemia / Q000628:therapy*