Endocrine Abstracts

Background: Ergot-derived dopamine agonist therapy (EDDAT) is associated with cardiac valvulopathy in Parkinson’s disease. The risk to patients with prolactinomas is uncertain. The EMEA/MRHA and BSE recently issued guidelines for surveillance echocardiography (ECHO) of patients receiving treatment with EDDAT. Our policy is to arrange opportunistic ECHO screening at first clinic visit guidelines.

Objective: We investigated the uptake and findings of echocardiography in this cohort.

Methods: From our endocrine database we identified patients with hyperprolactinaemia receiving treatment with bromocriptine or cabergoline who attended between 01/07/2008 and 31/10/2009. We audited their treatment, ECHO request, ECHO findings and communication of results to the GP.

Findings: One hundred and thirty-five patients received treatment with either cabergoline (110) or bromocripotine (25). A number of patients had used bromocriptine before cabergoline. The average weekly dose of cabergoline was 0.83 mg (0.125–5), average daily dose of bromocriptine was 3.35 mg (0.5–7.5). Average treatment duration was 7.6 years (0–39).

ECHO was requested for 73 (54%) patients. Fifty-five ECHOs were performed. Results were communicated to the GP in 28 (51%) of patients. Thirteen ECHOs are pending or done locally. ECHO was normal in 40 (73%). Fourteen patients (25%) had trivial/mild regurgitation of at least one valve, eight (15%) had mild tricuspid regurgitation and 11 (20%) mild mitral regurgitation, one (2%) pulmonary regurgitation and four (7%) had minimal valve leaflet thickening. One patient (2%) had moderate mitral regurgitation.

Conclusion: In daily clinical practice in a specialised pituitary unit the cardiac surveillance guidance was followed in only half of all eligible patients and results were communicated in only half of those. Systematic call-back may increase uptake. We did not find clinically significant valvular heart disease in this cohort. Over a quarter of patients exhibited mild valve abnormalities that will warrant reevaluation to ensure they do not worsen on continued EDDAT.