title: Withdrawal of dopamine agonist therapy in prolactinomas: In which patients and when?
abstract: OBJECTIVE
  The aim of the study was to assess the effect of dopamine agonist (DA) withdrawal, the current recurrence rate of hyperprolactinemia, and possible factors that predict recurrence in patients with prolactinoma.
  
  
  METHODS
  We evaluated DA withdrawal in 67 patients with prolactinoma (50 female/17 male) who received DA treatment for at least 2 years and showed normalization of prolactin (PRL) levels and tumor disappearance or ≥50 % tumor shrinkage, retrospectively. Accordingly, patients were divided into two groups as remission and recurrence groups, and factors that predict recurrence were evaluated.
  
  
  RESULTS
  The overall remission rate was 46 %; the remission ratios were 65 % in microprolactinomas and 36 % in macroprolactinomas. Remission rates were 39 % in the bromocriptine withdrawal group and 55 % in the cabergoline withdrawal group. The maximum tumor diameter and baseline PRL levels were significantly higher in the recurrence group (p = 0.001 and p = 0.003, respectively). The mean duration of DA therapy was significantly longer in the remission group (88.7 ± 48.1 and 66.7 ± 30.4 months, respectively, p = 0.026).The mean time to recurrence was 5.3 ± 3.2 months. The mean PRL levels at recurrence time were significantly lower than baseline PRL levels (p = 0.001).
  
  
  CONCLUSIONS
  The most important predictors of recurrence were maximum tumor diameter and baseline PRL levels in this study. The remission rate in our study group was higher, which was thought to be associated with the longer duration of DA treatment and that our patients were selected according to certain criteria. Despite these positive results, close monitoring is necessary for detection of early and late recurrence, especially within the first year after DA withdrawal.
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Capa, 34090, Istanbul, Turkey. sdogansen@gmail.com.
authors.forename: Sema Ciftci
authors.initials: SC
authors.lastname: Dogansen
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Capa, 34090, Istanbul, Turkey.
authors.forename: Ozlem Soyluk
authors.initials: OS
authors.lastname: Selcukbiricik
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Capa, 34090, Istanbul, Turkey.
authors.forename: Seher
authors.initials: S
authors.lastname: Tanrikulu
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Capa, 34090, Istanbul, Turkey.
authors.forename: Sema
authors.initials: S
authors.lastname: Yarman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001971:Bromocriptine / Q000008:administration & dosage*; D000077465:Cabergoline; D000069340:Deprescriptions; D018491:Dopamine Agonists / Q000008:administration & dosage*; D004873:Ergolines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D018579:Patient Selection; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; D011388:Prolactin; D000077465:Cabergoline
keywords: Bromocriptine; Cabergoline; Dopamine agonist withdrawal; Prolactinoma; Recurrence
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