Prolactinomas treated with dopaminergic agonists: behavior in different moments of life

Abstract Objective: To evaluate the behavior of pituitary adenomas following cessation of cabergoline (CAB) treatment, postpartum, and postmenopause, in comparison to idiopathic hyperprolactinemia (HPRL). Methods: This retrospective cohort study included women with HPRL treated with CAB under three conditions: treatment for at least two years and follow-up for a minimum of one year after treatment discontinuation, postpartum, and postmenopause. The evaluated parameters included tumor size, prolactin (PRL) levels, and clinical symptomatology. Results: A total of 160 women with idiopathic HPRL, micro- or macroadenomas, with symptom onset at 29.3±9.0 years, were included. Menstrual alterations occurred in 70% and galactorrhea in 63% of cases. PRL normalization occurred more rapidly in idiopathic HPRL than in tumors. However, symptom resolution required a similar time across all groups. All macroadenomas regressed to <10 mm. After CAB withdrawal, reintroduction was necessary in all macroadenomas, 53% of microadenomas, and 23% of idiopathic HPRL. Following postpartum CAB withdrawal, mean serum PRL levels increased by 300% in macroadenomas, 218% in microadenomas, and 11% in idiopathic HPRL; approximately 75% of all patients experienced symptom recurrence. Postmenopausal PRL normalization occurred in over 40% of cases. One untreated idiopathic HPRL case developed a microadenoma 12 months after menopause. Conclusion: HPRL presented a high recurrence rate following CAB discontinuation, regardless of tumor presence or treatment duration, with no reduction in recurrence observed after the postpartum period.