Keywords
Hiperprolactinemia
agonistas de dopamina
cabergolina
bromocriptina
Hyperprolactinemia
Dopamine agonists
Cabergoline
Bromocriptine
How to Cite
Abstract
Introducción: El prolactinoma es el tumor hipofisiario funcionante más frecuente.
Objetivo: Describir la experiencia del servicio de endocrinología del Hospital San José de Bogotá en el manejo de pacientes con prolactinoma que consultaron entre enero de 2006 y diciembre de 2012.
Métodos: Serie de casos. Se describieron variables demográficas, clínicas, seguimiento radiológico anual, prolactina (PRL) basal, a los 6 y 24 meses. Ingresaron pacientes con adenoma hipofisario documentado por resonancia nuclear magnética (RNM) contrastada, PRL sérica mayor de 100 ng/ml, o diagnóstico extrainstitucional de prolactinoma.
Resultados: Se analizaron 95 pacientes; 71% con microprolactinomas y 28,4% con macroprolactinomas. La mediana de duración del tratamiento en pacientes con microprolactinomas fue 73,4 meses con una mediana de dosis acumulada de cabergolina (CAB) de 52 mg. En las personas con macroprolactinoma fue de 65 meses, con mediana de dosis acumulada de CAB de 156 mg. El 78,3% inició tratamiento con bromocriptina (BRC). Ocho pacientes cumplieron criterios de remisión.
Conclusión: La población atendida en el Hospital San José tiene características similares a las registradas en la literatura; sin embargo, el porcentaje de remisión es bajo, lo cual, posiblemente está asociado al uso de bajas dosis de agonistas de dopamina. Se requieren estudios prospectivos para aclarar si la dosis acumulada es un factor predictor para aumentar el porcentaje de pacientes con retiro exitoso y establecer la mejor estrategia para retiro de agonistas de dopamina en pacientes con prolactinomas.
Summary
Objective: To describe our experience in the Endocrinology Service of Hospital San José in the treatment of patients with prolactinoma who were seen between 2006 and 2012.
Methodology: Case series. Demographic and clinical variables were described, as well as radiological monitoring once yearly and basal prolactin (PRL) measurements at 6 and 24 months. The patients included suffered from pituitary adenoma documented by contrast magnetic resonance imaging (cMRI), with serum PRL 100 ?g/L or above, or who had been diagnosed with prolactinoma by another institution.
Results: 95 patients were analyzed. 71% presented with microprolactinomas and 28.9% with macroprolactinomas. The median treatment duration for patients with microprolactinomas was 73.4 months, with a median accumulated dosage of cabergoline (CAB) of 52 mg. For macroprolactinomas, the median treatment duration was 65 months and the median accumulated dose of cabergoline was 156 mg. 73.8% of patients received bromocriptine. Eight patients met remission criteria.
Conclusion: The patient population treated at Hospital San José has similar features to that described in the literature. However, the remission rate is low, possibly explained by the use of low doses of dopamine agonists. Prospective studies are required to clarify whether the cumulative dose is a predictive factor for increasing the rate of patients with successful with- drawal and to establish the best strategy to withdraw dopamine agonists in patients with prolactinomas.
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