What is the prognosis of prolactinomas?

Updated: Mar 25, 2018
  • Author: Venkatesh Babu Segu, MD, MBBS, DM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Patients with microprolactinoma generally have an excellent prognosis. In up to 95% of patients, these tumors do not enlarge over a 4- to 6-year follow-up period. These patients generally do well for extended periods on suppressive therapy with DA agonists.

Macroprolactinomas have a tendency to grow with time and require aggressive treatment to prevent complications. The growth rate varies with the individual and cannot be reliably predicted. Careful monitoring of clinical signs and symptoms, coupled with pituitary imaging and with serial measurements of serum PRL levels (ie, to detect any major change in tumor behavior), remain the cornerstones of follow-up for these patients. [17] .

A study by Sala et al indicated that in patients with prolactinomas undergoing cabergoline treatment, the prolactinoma recurrence rate does not decline even if therapy is continued for over 3 years prior to withdrawal. In the study, 74 patients with a prolactinoma were separated into three groups, including those treated with cabergoline for 3 years, those treated for 3-5 years, and those treated for more than 5 years. The prolactinoma recurrence rate within 12 months of treatment withdrawal did not significantly differ between the groups. Moreover, microadenomas and macroadenomas showed a similar recurrence risk, although patients with pituitary deficits at diagnosis had a higher rate of recurrence. [18]  Most endocrinologists would recommend a drug holiday at 2 years of therapy to determine whether, after 3 months of observation, drug treatment needs to be continued. Patients requiring drug treatment at three years would obviously include a significant number of those who failed the drug holiday at 2 years. One would, therefore, not expect any difference in the recurrence rate at 3 years or after, as borne out in this study.

In contrast to the Sala study’s results, however, a report by Teixeira et al found evidence that macroprolactinomas have a higher relapse rate than do microprolactinomas following dopamine agonist withdrawal. [19]

A population-based, retrospective, open-cohort study by Toulis et al indicated that prolactinomas in males, but not females, increase their risk of incident cardiovascular disease (CVD). The investigators found that males in the study had an incident CVD rate of 14.8 per 1000 person-years, compared with 1.8 per 1000 person-years for females. [20]


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