Treatment of hyperprolactinemia: a systematic review and meta-analysis
1 Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
2 Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
3 Division of Preventive Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
4 Division of Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
5 Endocrinology, Diabetes and Nutrition Unit, Hospital Universitari de Girona, Dr. Josep Trueta, Avinguda de França, Girona, 17007, Spain
6 Hospital Nacional de Geriatría y Gerontología, Caja Costarricense de Seguro Social, Avenue 8, San José, Costa Rica
7 Division of Endocrinology and Metabolism, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
8 Mayo Clinic Libraries, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
Systematic Reviews 2012, 1:33 doi:10.1186/2046-4053-1-33Published: 24 July 2012
Hyperprolactinemia is a common endocrine disorder that can be associated with significant morbidity. We conducted a systematic review and meta-analyses of outcomes of hyperprolactinemic patients, including microadenomas and macroadenomas, to provide evidence-based recommendations for practitioners. Through this review, we aimed to compare efficacy and adverse effects of medications, surgery and radiotherapy in the treatment of hyperprolactinemia.
We searched electronic databases, reviewed bibliographies of included articles, and contacted experts in the field. Eligible studies provided longitudinal follow-up of patients with hyperprolactinemia and evaluated outcomes of interest. We collected descriptive, quality and outcome data (tumor growth, visual field defects, infertility, sexual dysfunction, amenorrhea/oligomenorrhea and prolactin levels).
After review, 8 randomized and 178 nonrandomized studies (over 3,000 patients) met inclusion criteria. Compared to no treatment, dopamine agonists significantly reduced prolactin level (weighted mean difference, -45; 95% confidence interval, -77 to −11) and the likelihood of persistent hyperprolactinemia (relative risk, 0.90; 95% confidence interval, 0.81 to 0.99). Cabergoline was more effective than bromocriptine in reducing persistent hyperprolactinemia, amenorrhea/oligomenorrhea, and galactorrhea. A large body of noncomparative literature showed dopamine agonists improved other patient-important outcomes. Low-to-moderate quality evidence supports improved outcomes with surgery and radiotherapy compared to no treatment in patients who were resistant to or intolerant of dopamine agonists.
Our results provide evidence to support the use of dopamine agonists in reducing prolactin levels and persistent hyperprolactinemia, with cabergoline proving more efficacious than bromocriptine. Radiotherapy and surgery are useful in patients with resistance or intolerance to dopamine agonists.