PROLACTINOMA : Treatment and outcome of patients in a Swedish county

University essay from Örebro universitet/Institutionen för medicinska vetenskaper

Abstract: Introduction: Dopamine agonists (DA) constitute primary treatment for prolactinomas.Recent international guidelines on prolactinoma management recommend use of cabergolineover other DAs and suggest attempting withdrawal after two years given certain criteria. Thelocal data on adherence to guidelines are scarce. Aim: This study aimed to compare local clinical practice to regional and internationalguidelines for prolactinomas and investigate management and outcome of patients with thisdiagnosis in a clinical setting in Örebro county. Methods: Medical records of patients with prolactinoma visiting the unit of endocrinology atÖrebro University Hospital between 2015-2019 were reviewed. Data on initial investigations,monitoring, treatment, and outcome were collected. Results: 91 patients with a median follow-up time of 69 months, were included. All patientshad initial investigations according to regional guidelines. 98.9% were ever treated with DA,and overall use of bromocriptine was higher than that of cabergoline. DA-withdrawal wasattempted in 40% of patients after a median treatment time of 6 years and was often successful.9.9% of patients had pituitary surgery. At last follow-up 37.4% of the patients were cured while20.9% had hypopituitarism. Treatment outcome differed significantly with adenoma size;microadenomas dominated among patients cured and macroadenomas among patients withremaining hypopituitarism (p<0.001). Conclusions:Local diagnostic prolactinoma care is in line with regional guidelines and patients are monitoredregularly. However, it is feasible that local practice concerning the choice of dopamine agonistand routines for its withdrawal could be revised and adjusted to international guidelines.

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