Endocrine Abstracts

Background: Dopamine agonists (DAs) were associated with valvular dysfunction in patients with Parkinson’s disease due to their fibrotic effect through the serotoninergic receptor. It is more difficult to prove the same effects in patients with prolactinoma due to the lower doses, variable doses and the longer follow-up period.

Aim: To assess echocardiographic features in patients with prolactinoma under DA treatment.

Methods: Files of 91 patients diagnosed with prolactinoma were retrospectively assessed; 27 patients had at least one transthoracic echocardiographic (TTE) evaluation and were included in the analysis – 19 men and 8 women, median age at diagnosis 35 years-old (16-76), followed-up for a median of 5.4 years (0.2-18.4), macroadenomas prevailed (26 of 27 adenomas); median prolactin at diagnosis was 1363.7 ng/mL (75.5-30554). All subjects were treated with DAs – 25 with cabergoline (CAB) only, 1 with bromocriptine (BRC) only and one with both, consecutively. Median maximum CAB dose was 3.25 mg/week (0.5-14) with a median cumulative dose of 842.4 mg*year. Excepting 5 subjects, the rest were cured/controlled. Prolactin was measured by chemiluminescence.

Results: TTE was performed in only 29.7% of patients, despite high doses, long-term duration of DA treatment and presence of cardiovascular risk factors. All 27 patients had at least one classic cardiovascular risk factor (CVRF) – male gender (70%), age >55 years in men and >65 years in women (26%), smoking (19%), obesity (44%), dyslipidemia (78%), arterial hypertension (33%), diabetes mellitus (4%) and chronic kidney disease (33%). In average, the subjects had 3 CVRF Sixteen (60%) of patients had abnormal TTE during follow-up: 33% left ventricular hypertrophy (LVH), 40.7% had at least one grade I-II/IV valvular regurgitation (25.9% mitral and tricuspid and/or aortic, 11.1% isolated mitral, 3.7% isolated tricuspid); left ventricular function was normal in all patients but one, who showed mildly reduced left ventricular ejection fraction; 7 patients showed diastolic dysfunction. Maximum CAB dose > 2 mg/week was associated with mitral regurgitation (P< 0.05). No patient required withdrawal of DA due to valve involvement. Study limitations include the small number of patients and non-standardized TTE evaluation.

Conclusion: TTE is still underperformed in long-term DA treated prolactinoma patients. Although atrio-ventricular regurgitation (mitral, tricuspid or both) was more frequent in our series than that reported in the general population, regurgitations were mild and clinically nonsignificant. Due to high prevalence of associated cardiovascular risk factors, lifestyle changes should become part of prolactinomas’ approach.