Long-term evolution and outcomes of microprolactinoma with medical treatment.

INTRODUCTION Prolactinoma is the most frequent functioning pituitary adenoma. Most commonly occurs as microprolactinoma (less than 1cm in size), which may be cured with medical therapy, but few long-term studies are available about optimal duration of treatment with dopamine agonists to ensure cure after drug discontinuation and its withdrawal without recurrence are do not report consistent results. OBJECTIVE To establish criteria for cure of microprolactinoma with medical treatment and to analyze the potential predictors involved. PATIENTS A retrospective study was conducted on 47adult women with microprolactinoma followed up between 1975 and 2010; none of them had undergone prior surgery or radiotherapy, and all of them received treatment with a dopamine agonist for at least 4years. They were divided into two groups for analysis: cured patients with at least 4years with normal prolactin levels after drug discontinuation, and not cured patients. RESULTS Cure was achieved in 57.4% of patients. Only age at diagnosis was a significant predictor: there were more young patients in the cured group and youngest patients needed less time to cure. Development of empty sella turcica or normal MRI were similar regarding time to cure. CONCLUSIONS Microprolactinoma may be cured with dopamine agonists, and life-long treatment is not required, although more than 10years may be required to achieve cure, 11,6±5,3 years in our experience.