Endocrine Abstracts

Ergot derived dopamine agonist therapy (EDDAT) has recently been associated with fibrotic cardiac valvulopathy in patients with Parkinson’s disease. These patients received a cumulative dose of 2800–6700 mg of cabergoline for an average duration of two years. This has raised concerns about the use of these agents in patients with prolactinomas and has led to the recent EMEA/MHRA guidance that all patient being treated with EDDA should undergo surveillance echocardiograms. EDDAT is used in lower doses to treat prolactinomas however, treatment duration may be longer, and cumulative dose, or even just duration of therapy, may be important. The risk to patients with prolactinomas remains uncertain.

The objective of this observational study was to investigate for the presence of valvulopathy in patients on long-term low-dose EDDAT for prolactinoma. Local Ethical Committee approval was obtained and patients with treatment duration longer than 4 years were studied using transthoracic echocardiography. A total of 22 patients (18 women, 4 men) with an average age of 50.2±9.7 years, were studied. The duration of treatment was 9.9±4.4 years. 12 patients had taken only cabergoline, 2 bromocriptine and 8 patients had taken both agents. The cumulative dose of cabergoline was 146.5 (4.2–2589) mg and bromocriptine 5181 (243 to 33265) mg.

Echocardiography showed 17 (77%) patients had trace/trivial regurgitation of at least one valve, two patients (9%) showed mild tricuspid regurgitation and two (9%) mild mitral regurgitation. 5 (23%) patients had minimal heart valve leaflet thickening.

Conclusion: We have not found any clinically significant cardiac valve regurgitation (moderate or severe) or restrictive valvular heart disease in this cohort of patients with a particularly long duration EDDAT. Some individuals exhibited mild valve abnormalities that may warrant re-evaluation to ensure they do not worsen on continued EDDAT, as recommended by the EMEA/MHRA.