Aim: Over the last decade, cardiac valvular fibrosis has been associated with the use of high dose (ergot-derived) dopamine agonist therapy in Parkinsons disease. Although the risk in endocrine patients appears significantly lower, routine echocardiographic monitoring is now recommended. This study evaluated the incidence of significant cardiac valvulopathy in endocrine patients treated with cabergoline in a District General Hospital Population, and compliance with MHRA 2008 recommendations for chronic endocrine use of ergot-derived dopamine agonists.
Methods: We identified 18 patients treated with cabergoline in the Endocrine Clinic over a 6 year period (August 2004 May 2010), 16 for hyperprolactinaemia (8 with microadenoma, 4 with macroadenoma and 4 with primary hyperprolactinaemia) and 2 for acromegaly. For hyperprolactinaemia mean (±S.D.) age was 40.75 (±17.79) years, 88% were female (n=16). The median (range) cumulative dose of cabergoline was 88 mg (9781) and treatment duration 33 months (6152). Both acromegaly patients were female, age 81 and 73 years, cumulative cabergoline doses 1564 and 715 mg, and treatment duration 10 years and 6 years and 9 months, respectively.
Results: Baseline echocardiography was documented in 86% patients. 81% of eligible patients received echocardiography monitoring as per MHRA guidelines. In the hyperprolactinaemia patients, no significant cardiac valvulopathy was identified (one case of mild aortic regurgitation (with no serial progression), all others echocardiographically normal). Both acromegaly patients were found to have significant aortic valve disease (moderate AR).
Conclusions: In our cohort we found no evidence of new or worsening valvular lesions in hyperprolactinaemic patients treated with cabergoline. In line with other similar studies, the risk of cardiac valvulopathy in hyperprolactinaemic patients treated with standard doses of cabergoline appears low. Although acromegaly is associated with cardiac valvulopathy per se, it is noteworthy that these patients received higher doses and longer duration of treatment and both developed valvulopathy.