Recurrencia tras la retirada del tratamiento en las hiperprolactinemias

Recurrence of Hyperprolactinemia after Withdrawal of Dopamine Agonists: Systematic Review and Meta-Analysis

J Clin Endocrinol Metab 95: 43–51, 2010

Resumen de este trabajo , que creo tiene implicaciones clínicas prácticas de gran valor.

This meta-analysis aims to assess the effect of dopamine agonist withdrawal in patients with idiopathic hyperprolactinemia and prolactinomas.19 studies were included-total of 743 patients.

Results:

· The pooled proportion of patients with persisting normoprolactinemia after dopamine agonist withdrawal was 21% [95% CI, 14–30%; I2 81%).

· idiopathic hyperprolactinemia (32%; 95% CI, 5–80%)

· microprolactinomas (21%; 95% CI, 10–37%),

· macroprolactinomas (16%; 95% CI, 6–36%).

· In a random effects meta-regression adjusting for cause of hyperprolactinemia, a longer treatment duration was associated with treatment success (P _ 0.015).

Conclusions: This meta-analysis showed that hyperprolactinemia will recur after dopamine agonist withdrawal in a considerable proportion of patients. The probability of treatment success was highest when cabergoline was used for at least 2 yr.

What are the clinical implications of the present meta-analysis?

1. Hyperprolactinemia likely will recur after dopamine agonist withdrawal
2. The probability of treatment success is highest when cabergoline is used for at least 2 yr.
3. Observational studies have not reported clinical relevant cardiac valve disease after treatment with cabergoline for prolactinomas.