Metabolic effects of dopamine agonists in patients with prolactinomas: a systematic review and meta-analysis

Abstract

Objectives: Recent large cohort studies suggest an association between high plasma prolactin and cardiovascular mortality. The objective of this systematic review was to systematically assess the effect of reducing prolactin with d opamine agonist on established cardiovascular risk factors in patients with prolactinomas. Design: Bibliographical search was done until February 2019 searching the following databases: PubMed, EMBASE, WHO and LILAC. Eligible studies had to include participants with verified prolactinomas where metabolic variables were asses sed before and after at least 2 weeks treatment with dopamine agonists. Methods: Baseline data and outcomes were independently collected by two investigators. The study was registered with PROSPERO (registration number CRD42016046525). Results: Fourteen observational studies enrolling 387 participants were included. The pooled standardized mean difference of the primary outcome revea led a reduction of BMI and weight of −0.21 (95% CI −0.37 to −0.05; P = 0.01; I2 = 71%), after treatment. Subgroup analysis suggested that the reduction of weight was primarily driven by studies with high prolactin levels at baseline (P = 0.04). Secondary outcomes suggested a small decrease in waist circumference, a small-to-moderate decrease in triglycerides, fasting glucose levels, HOMA-IR, HbA1c and hsCRP, and a moderate decrease in LDL, total cholesterol and insulin. Conclusion: This systematic review suggests a reduction of weight as well as an improved lipid profile and glucose tolerance after treatment with dopamin e agonist in patients with prolactinomas. These data are based on low-quality evidence.

Keywords

• prolactinoma
• dopamine agonist
• weight
• BMI
• metabolic effect