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Speed of response to dopaminergic agents in prolactinomas

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Abstract

Purpose

Hyperprolactinemia in the presence of a sellar lesion can be caused by prolactin secretion from the lesion, or by increased intrasellar pressure/compression of the pituitary stalk (“stalk effect”). The objective of this work was to determine the response to dopamine agonists (DAs) in bona fide prolactinomas presenting with a prolactin range similar to what can be seen in nonhormonal secreting pituitary tumors.

Methods

A descriptive study on 68 prolactinomas presenting with prolactin levels between 50 and 200 ng/mL in a tertiary center in the U.S.A. over 22 years. The main outcome was prolactin decrease from diagnosis to follow-up by 2 months from initiation of DA therapy.

Results

With a median time to follow-up from starting DA therapy of 5 weeks [IQR:4, 6], the median prolactin check showed normality at 11.85 ng/mL [IQR: 5.1, 29]. The median prolactin percent change was at 87% [IQR:67, 94] by 2 months. The majority (75%) of patients presenting had a 2/3 (67%) prolactin drop by 2 months, with more than 1/4 (25%) having a percent drop >95%.

Conclusions

A rapid decline in prolactin level can be seen in prolactinomas upon initiation of DA therapy. This significant prolactin drop restricts the ability to establish a threshold beyond which the diagnosis of prolactinoma could be excluded.

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Acknowledgements

The authors wish to thank the Ward family for their generous support.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, and Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Camille Hage & Roberto Salvatori

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  1. Camille Hage
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  2. Roberto Salvatori
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Correspondence to Roberto Salvatori.

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The authors have no financial or nonfinancial interests that are directly or indirectly related to the work submitted. This work was approved by the local IRB, and no consent form for subjects was deemed necessary due to its retrospective nature.

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Hage, C., Salvatori, R. Speed of response to dopaminergic agents in prolactinomas. Endocrine 75, 883–888 (2022). https://doi.org/10.1007/s12020-021-02953-1

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