Prolactinomas: evolution after menopause

ABSTRACT Objetive The aim was to assess the evolution of tumor size and prolactin (PRL) levels in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists during fertile age, and the effects of suspension of drugs after menopause. Retrospective study, 29 patients with prolactinomas, 22 microadenomas and 7 macroadenomas, diagnosed during their fertile age were studied in their menopause; treatment was stopped in this period. Age at menopause was 49 ± 3.6 years. The average time of treatment was 135 ± 79 months. The time of follow-up after treatment suspension was 4 to 192 months. Results Pre-treatment PRL levels in micro and macroadenomas were 119 ± 57 ng/mL and 258 ± 225 ng/mL, respectively. During menopause after treatment suspension, and at the latest follow-up: in microadenomas PRL levels were 23 ± 13 ng/mL and 16 ± 5.7 ng/mL, respectively; in macroadenomas, PRL levels were 20 ± 6.6 ng/mL 5t5and 25 ± 18 ng/mL, respectively. In menopause after treatment suspension, the microadenomas had disappeared in 9/22 and had decreased in 13/22. In the group of patients whose tumor had decreased, in the latest follow-up, tumors disappeared in 7/13 and remained unchanged in 6/13. In macroadenomas, after treatment suspension 3/7 had disappeared, 3/7 decreased and 1/7 remained unchanged. In the latest control in the 3 patients whose tumor decreased, disappeared in 1/3, decreased in 1/3 and there was no change in the remaining. Conclusions Normal PRL levels and sustained reduction or disappearance of adenomas were achieved in most of patients, probably due to the decrease of estrogen levels. Dopamine agonists might be stopped after menopause in patients with prolactinomas.摘要 ## 研究目的 本研究旨在评估生育期确诊并接受多巴胺受体激动剂（dopamine agonists）治疗的微催乳素瘤（microprolactinoma）与大催乳素瘤（macroprolactinoma）患者的肿瘤体积及催乳素（prolactin, PRL）水平变化，以及绝经后停药的相关影响。 ## 研究方法 本研究为回顾性研究，纳入29例于生育期确诊的催乳素瘤患者，其中22例为微催乳素瘤，7例为大催乳素瘤，所有患者均在绝经阶段停止治疗。患者绝经时年龄为49±3.6岁，平均治疗时长为135±79个月，停药后随访时间为4~192个月。 ## 研究结果 治疗前，微催乳素瘤与大催乳素瘤患者的PRL水平分别为119±57 ng/mL与258±225 ng/mL。停药后绝经阶段及末次随访时，微催乳素瘤患者的PRL水平分别为23±13 ng/mL与16±5.7 ng/mL；大催乳素瘤患者的PRL水平分别为20±6.6 ng/mL与25±18 ng/mL。 停药后绝经阶段，22例微催乳素瘤患者中9例肿瘤完全消失，13例肿瘤体积缩小；其中肿瘤体积缩小的亚组中，末次随访时7例肿瘤完全消失，6例肿瘤体积无变化。 7例大催乳素瘤患者中，3例肿瘤完全消失，3例肿瘤体积缩小，1例肿瘤体积无变化；在肿瘤体积缩小的3例患者中，末次随访时1例肿瘤完全消失，1例肿瘤体积仍有缩小，1例无明显变化。 ## 研究结论 多数患者的PRL水平恢复正常，腺瘤体积持续缩小或完全消失，这可能与绝经后雌激素水平下降有关。催乳素瘤患者可在绝经后停用多巴胺受体激动剂。