Endocrine Abstracts

Introduction: Dopamine agonists are commonly used for the treatment of Parkison’s disease and prolactinomas. Sometimes high doses are needed in mixed pituitary adenomas. This medical treatment usually induces gastrointestinal troubles and/or low blood pressure, and sometimes psychiatric disorders. Pleuropercarditis effusion (PPE) is rarely related to dopamine agonist side effects.

Case report: Our aim is to report a man aged 29 years old whose PPE is apparently due to high dose and chronic bromocriptine intake.

This person, followed for 4 years for a somato-lacto-thyreotrop pituitary macro adenoma, was first treated by a combination of anti thyroid drugs, somatostatin’s analogs and bromocriptine (12.5 mg/day). After normal thyroid function achievement, he was operated via transphenoidal approach. Unfortunately, pituitary surgery was totally unsuccessful, as he had only a biopsy. This situation obliged us to prescribed bromocriptine again with a higher dose (25 mg/day). Eighteen months later, this man had an acute respiratory distress with orthopnea and muffling of heart sounds without fever or alteration of his general condition.

Chest X-rays revealed a mild right pleural effusion with normal lung parenchyma. Echocardiography showed abundant pericarditis effusion that required paracentesis. Abdominal ultrasound did not find peritoneal effusion.

Cardiovascular, hepatic and renal causes were excluded. Research for neoplasms and tuberculosis were negative. Protein electrophoresis and thyroid function were normal too. As we did not have any aetiology, the iatrogenic cause seemed more probable, so bromocriptine was stopped. For more than 2 years, we did not notice any PPE relapsing which reinforced our supposition. The mechanism of PPE secondary to ergocriptine intake is probably immuno-allergic.

Conclusion: PPE secondary to bromocriptine intake is an exceptional adverse effect that should be kept in mind after exclusion of PPE’s classical aetiologies. Periodic echocardiography and chest X-ray should be done in patients under long-term bromocriptine therapy.