Prolactinomas : predictores de remisión y recurrencia después del retiro de los agonistas dopaminérgicos
Fecha
2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Los prolactinomas son los adenomas hipofisarios que secretan prolactina. Los agonistas de dopamina son el tratamiento de elección. Los criterios que deben guiar la retirada de la terapia y los factores que influyen en la remisión o la recurrencia de la enfermedad aún no están completamente establecida. El propósito de esta investigación tiene como objetivo la evaluación de pacientes que intentaron el retiro del agonista de dopamina. Además se estudiaron los factores que pueden predecir la decisión del médico de interrumpir el tratamiento y determinar que pacientes logran la remisión y recurrencia. La metodología empleada fue un estudio retrospectivo, observacional de corte transversal y de tipo descriptivo correlacional de 62 pacientes con diagnóstico de prolactinomas atendidos en el hospital del IESS “Dr. Teodoro Maldonado Carbo” Enero 2012 - Agosto 2018 que han sido tratados exclusivamente con agonistas de dopamina. La gestión de datos se realizó en hojas de cálculo de Microsoft Excel 2010, donde se realizó el procesamiento de datos y para el análisis estadístico se manejó el programa SPSS versión 23. Los resultados reportan que el agonista de dopamina se retiró en un 48,39% de los pacientes. La tasa de remisión fue del 30%, (micro 36,36% y macro12,50%). La tasa de recurrencia fue del 70,00%, los macroprolactinomas presentaron mayor tasa de recurrencia del 87,50% que los microprolactinomas. Conclusiónes: La terapia con agonista de dopamina puede descontinuarse pero con alta tasa de recurrencia. Las mujeres, pacientes con microprolactinomas, niveles más bajos de prolactina al diagnóstico y con una duración de la terapia de dos años tienen más probabilidades de considerar la suspensión adecuada de la medicación.
Palabras claves:
Prolactinomas are pituitary adenomas that secrete prolactin. Dopamine agonists are the treatment of choice. The criteria that should guide the withdrawal of therapy and the factors that influence remission or recurrence of the disease are not yet fully established. The purpose of this research is aimed at the evaluation of patients who attempted the withdrawal of the dopamine agonist. In addition, factors that can predict the physician's decision to interrupt treatment and determine which patients achieve remission and recurrence were studied. The methodology used was a retrospective, cross-sectional observational and descriptive correlational study of 62 patients diagnosed with prolactinomas seen in the IESS hospital "Dr. Teodoro Maldonado Carbo "January 2012 - August 2018 that have been treated exclusively with dopamine agonists. The data management was done in Microsoft Excel 2010 spreadsheets, where the data processing was performed and for the statistical analysis the SPSS program version 23 was handled. The results report that the dopamine agonist was withdrawn in a 48.39 % from the patients. The remission rate was 30% (micro 36.36% and macro12.50%). The recurrence rate was 70.00%, the macroprolactinomas presented a higher recurrence rate of 87.50% than the microprolactinomas. Conclusions: Dopamine agonist therapy can be discontinued but with a high recurrence rate. Women, patients with microprolactinomas, lower prolactin levels at diagnosis and with a duration of therapy of two years are more likely to consider adequate suspension of medication.
Prolactinomas are pituitary adenomas that secrete prolactin. Dopamine agonists are the treatment of choice. The criteria that should guide the withdrawal of therapy and the factors that influence remission or recurrence of the disease are not yet fully established. The purpose of this research is aimed at the evaluation of patients who attempted the withdrawal of the dopamine agonist. In addition, factors that can predict the physician's decision to interrupt treatment and determine which patients achieve remission and recurrence were studied. The methodology used was a retrospective, cross-sectional observational and descriptive correlational study of 62 patients diagnosed with prolactinomas seen in the IESS hospital "Dr. Teodoro Maldonado Carbo "January 2012 - August 2018 that have been treated exclusively with dopamine agonists. The data management was done in Microsoft Excel 2010 spreadsheets, where the data processing was performed and for the statistical analysis the SPSS program version 23 was handled. The results report that the dopamine agonist was withdrawn in a 48.39 % from the patients. The remission rate was 30% (micro 36.36% and macro12.50%). The recurrence rate was 70.00%, the macroprolactinomas presented a higher recurrence rate of 87.50% than the microprolactinomas. Conclusions: Dopamine agonist therapy can be discontinued but with a high recurrence rate. Women, patients with microprolactinomas, lower prolactin levels at diagnosis and with a duration of therapy of two years are more likely to consider adequate suspension of medication.
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Prolactinoma, Agonistas de dopamina, Recurrencia, Remisión, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador, Epidemiología descriptiva, Estudios retrospectivos