ECE2014 Poster Presentations Pituitary Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (108 abstracts)
Recurrence of hyperprolactinemia after withdrawal of cabergoline in prolactinomas
Elisa Sala 1, , Paola Bellaviti 1, , Emanuele Ferrante 2 , Elena Malchiodi 1, , Elisa Verrua 1, , Claudia Giavoli 2 , Eriselda Profka 1, , Paolo Beck-Peccoz 1, , Anna Spada 1, & Giovanna Mantovani 1,
1University of Milan., Milan, Italy; 2UO Endocrinology e Diabetology, Fondazione IRCCS Ca’ Granda Osp. Maggiore Policlinico, Department of Clinical Sciences and Community Healt, Milan, Italy.
Introduction: The optimal treatment duration for prolactinomas to minimize reccurences is not clear. 2011 Endocrine Society Guidelines suggested that cabergoline withdrawal may be safely undertaken after 2 years in patients achieving normoprolactinemia and tumor volume reduction.
Materials and methods: We analyzed 74 patients (mean age=46.9±14.4, M/F=19/56, macro/micro=18/56) bearing a prolactinoma. Patients were divided in 3 groups: Group A (23) treated for 3 years, Group B (23) for a period >3 years but <5 years, and Group C (28) for a period >5 years. Cabergoline therapy was stopped according to Endocrine Society Guidelines. PRL levels were measured 3, 6, 12 and 24 months after withdrawal. Reccurence was defined with PRL levels≥30 ng/ml.
Results: No difference in the three groups regarding the following clinical manifestation was observed: PRL levels 123.2±112.1, 120.9±123.8 and 176.6±154.0, macroadenoma in 13, 17 and 39%, pituitary deficit in 4, 17, and 17% of patients, mean weekly dose of 0.7±0.4, 0.6±0.3 and 0.7±0.4 and PRL levels before withdrawal 17.1±19.6, 11.4±8.8 and 13.8±13.5 in group A, B and C respectively. Recurrence occurred in 34 patients (45.9%): 11 (47%) patients in Group A, 12 (52%) in group B and 11 (39%) in Group C, without differences among groups.
All recurrences occurred within 12 months, in particular: in 15 patients (44%) after 3 months, in 13 (38%) after 6 months and in six patients (18%) after 12 months.
Interestingly, the number of pituitary deficit at diagnosis was significantly higher in patients with recurrence compared with patients in remission at long-term follow-up (eight patients (23%) vs 2 (5%), P=0.03).
Conclusion: Our data are in accordance with the literature regarding recurrence rate and timing after cabergoline withdrawal. In particular, prolonging therapy for more than 2 years does not reduce recurrence rate. Moreover, our study suggest, that patients with pituitary deficit at diagnosis need to be closely monitored.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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