Best candidates for dopamine agonist withdrawal in patients with prolactinomas
| Autor: | Myoung Jin Ji, Jung Hyun Lee, Ji Hyun Lee, Chan Soo Shin, Jung Hee Kim, Yong Hwy Kim, Sun Ha Paek, Seong Yeon Kim |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Cabergoline Adolescent Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Dopamine agonist 03 medical and health sciences Drug withdrawal Young Adult 0302 clinical medicine Endocrinology Internal medicine medicine Humans In patient Prolactinoma Ergolines Bromocriptine Aged Retrospective Studies business.industry Medical record Retrospective cohort study Middle Aged medicine.disease Magnetic Resonance Imaging 030220 oncology & carcinogenesis Dopamine Agonists Female business medicine.drug |
| Zdroj: | Pituitary. 20(5) |
| ISSN: | 1573-7403 |
| Popis: | Dopamine agonist (DA) therapy is recommended as the first-line treatment for prolactinomas. However, it requires long treatment duration, and a high recurrence rate after DA withdrawal has been reported. We aimed to elucidate the predictors for long-term remission following DA withdrawal and propose the best candidates who can achieve complete remission after DA withdrawal.In a retrospective cohort study, we included 89 patients with prolactinoma who have withdrawn DAs with normal prolactin (PRL) levels at Seoul National University Hospital, from 2000 to 2016. Patient's data were retrieved from the electronic medical records.The median age and median treatment duration of the study patients were 33 (15-73) years and 69.5 (8.3-277.4) months, respectively. The recurrence rate after drug withdrawal was 57.3% during the 23.9 (3.0-176.8) month follow-up period. Age, gender, baseline PRL level, and baseline maximum tumor diameter were similar between the remission and recurrence group. In the Cox-proportional hazard model analysis, the significant predictors for remission were nadir PRL level of1 ng/dL (hazard ratio [95% confidence interval] = 0.37 [0.18-0.74]), invisible tumors on magnetic resonance imaging (MRI) (0.42 [0.24-0.74]), and treatment duration of72 months (0.54 [0.30-0.96]). Of the subjects who met all the three criteria, 66.7% achieved long-term remission.Patients who have no tumor visible on MRI, have a nadir PRL level1 ng/dL during drug treatment, and received drug treatment for6 years may be the best candidates for DA withdrawal. |
| Databáze: | OpenAIRE |
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