title: MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment.
abstract: OBJECTIVE
  Both antitumor and antisecretory efficacies of dopamine agonists (DA) make them the first-line treatment of macroprolactinomas. However, there is no guideline for MRI follow-up once prolactin is controlled. The aim of our study was to determine whether a regular MRI follow-up was necessary in patients with long-term normal prolactin levels under DA.
  
  
  METHODS
  We conducted a retrospective multicenter study (Marseille, Paris La Pitie Salpetriere and Nancy, France; Liege, Belgium) including patients with macroprolactinomas (largest diameter: >10 mm and baseline prolactin level: >100 ng/mL) treated by dopamine agonists, and regularly followed (pituitary MRI and prolactin levels) during at least 48 months once normal prolactin level was obtained.
  
  
  RESULTS
  In total, 115 patients were included (63 men and 52 women; mean age at diagnosis: 36.3 years). Mean baseline prolactin level was 2224 ± 6839 ng/mL. No significant increase of tumor volume was observed during the follow-up. Of the 21 patients (18%) who presented asymptomatic hemorrhagic changes of the macroprolactinoma on MRI, 2 had a tumor increase (2 and 7 mm in the largest size). Both were treated by cabergoline (1 mg/week) with normal prolactin levels obtained for 6 and 24 months. For both patients, no further growth was observed on MRI during follow-up at the same dose of cabergoline.
  
  
  CONCLUSIONS
  No significant increase of tumor size was observed in our patients with controlled prolactin levels on DA. MRI follow-up thus appears unnecessary in patients with biologically controlled macroprolactinomas.
authors.affiliation: Aix Marseille UniversityAssistance Publique Hopitaux de Marseille, La Conception Hospital, Marseille, France.
authors.forename: J
authors.initials: J
authors.lastname: Eroukhmanoff
authors.affiliation: Groupe Hospitalier Pitié-Salpêtrière Service d'Endocrinologie & Médecine de la ReproductionParis, France.
authors.forename: I
authors.initials: I
authors.lastname: Tejedor
authors.affiliation: Domaine Universitaire du Sart Tilman CHU de Liège Service d'EndocrinologieLiege, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Potorac
authors.affiliation: CHU de Nancy - Hôpital de Brabois Clinique Médicale et EndocrinologiqueNancy, France.
authors.forename: T
authors.initials: T
authors.lastname: Cuny
authors.affiliation: Domaine Universitaire du Sart Tilman CHU de Liège Service d'EndocrinologieLiege, Belgium.
authors.forename: J F
authors.initials: JF
authors.lastname: Bonneville
authors.affiliation: Service de NeurochirurgieHôpital de la Timone, Marseille, France.
authors.forename: H
authors.initials: H
authors.lastname: Dufour
authors.affiliation: CHU de Nancy - Hôpital de Brabois Clinique Médicale et EndocrinologiqueNancy, France.
authors.forename: G
authors.initials: G
authors.lastname: Weryha
authors.affiliation: Domaine Universitaire du Sart Tilman CHU de Liège Service d'EndocrinologieLiege, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Beckers
authors.affiliation: Groupe Hospitalier Pitié-Salpêtrière Service d'Endocrinologie & Médecine de la ReproductionParis, France.
authors.forename: P
authors.initials: P
authors.lastname: Touraine
authors.affiliation: Aix Marseille UniversityAssistance Publique Hopitaux de Marseille, La Conception Hospital, Marseille, France.
authors.forename: T
authors.initials: T
authors.lastname: Brue
authors.affiliation: Aix Marseille UniversityAssistance Publique Hopitaux de Marseille, La Conception Hospital, Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Castinetti
mesh_terms: D000328:Adult; D000634:Aminoquinolines / Q000627:therapeutic use; D001530:Belgium; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011388:Prolactin / Q000097:blood*; D015175:Prolactinoma / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D000634:Aminoquinolines; D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; C046650:quinagolide; D011388:Prolactin; D000077465:Cabergoline