Endocrine Abstracts (2009) 20 P196

Safety of long-term combined therapy with somatostatin analogues and cabergoline (CAB) on cardiac valve in acromegaly: an echocardiography study

Renata Simona Auriemma1, Maurizio Galderisi2, Mariano Galdiero1, Ludovica Francesca Stella Grasso1, Maria Cristina De Martino1, Monica De Leo1, Annamaria Colao1 & Rosario Pivonello1

1Department of Clinical and Molecular Endocrinology and Oncology, University ‘Federico II’, Naples, Italy; 2Department of Clinical and Experimental Medicine, University ‘Federico II’, Naples, Italy.

The aim of the present study was to evaluate cardiac valve insufficiency prevalence after 12-month combined treatment with somatostatin analogues (SA) and CAB in acromegalic patients partially responsive to high-dose and long-term SA monotherapy. Twenty-four patients entered the study. A standard echocardiography was performed in all patients at diagnosis, after high-dose and long-term SA therapy and 12 months after CAB addition to SA to evaluate ejection fraction (EF) and mitralic (M), tricuspidal (T), aortic (A) and pulmunar (P) valve regurgitation (R). CAB was added at the initial dose of 1 mg weekly, then increased up to 0.5 mg daily after 3 months on the basis of GH and IGF-I levels. Compared to baseline, SA treatment induced a significant decrease, but not normalization, in GH (P<0.001) and IGF-I (P<0.001). After CAB addition, GH (P<0.001) and IGF-I (P=0.002) were furtherly decreased until normalization in all patients. Compared to baseline, EF was increased (P<0.001) after SA monotherapy, whereas CAB addition induced only slight, but not significant, further increase in EF. At the study entry, patients showed: mild MR in 85%, moderate MR in 4.2%, mild TR in 41.2%, moderate TR in 8.3%, mild AR 8.3%, moderate AR in 8.3% and mild PR in 16.6% of patients, respectively. After treatment with SA, mild MR (P=0.002), moderate TR (P<0.05) and mild PR (P<0.05) were decreased compared to baseline. After the addition of CAB to SA, mild MR and AR were furtherly reduced (P<0.001 and P<0.01 respectively); mild PR was increased (P<0.05) compared to SA therapy. However, no case of severe or moderate to severe valvular abnormality was observed. In conclusion, valve dysfunctions, particularly mild MR and AR, seem to be improved after CAB addition, although a slight impairment in mild PR was found. Therefore, long-term combined treatment with SA and CAB is effective and safe in acromegaly.