ergoline and Calcinosis

The use of high doses of the ergot-derived dopamine agonist cabergoline (> 3 mg/day), especially with cumulative doses > 4000 mg, has been associated with an increase in cardiac valvular thickening and significant (moderate to severe) regurgitation. Whether lower doses commonly used in the treatment of prolactinomas (0.25-3 mg/week) are also associated with significant valvulopathy is controversial. The mitral valve tenting area, a subclinical index of leaflet stiffening, has also been correlated with the cumulative dose of cabergoline and severity of valvular regurgitation.. We performed transthoracic echocardiography (TTE) on 50 prolactinoma patients (48% macroprolactinomas, 52% microprolactinomas, 30 male, 20 female, age 51.2 +/- 2.2 years, mean +/- SEM) who had been taking cabergoline for 6.6 +/- 0.5 years (range 1-13 years) with cumulative doses of 443 +/- 53 mg, to determine the prevalence of significant valvular thickening (> 0.5 cm) and regurgitation, and measured the mitral valve tenting area and height. The results were compared to those from age- and sex-matched controls with normal left ventricular function.. No significant valvular thickening or regurgitation of any valve was detected in the prolactinoma group and the prevalence of mild valvular regurgitation was not higher than in the case-control group. The mitral valve tenting area and height were not significantly greater than in the control group. There was no correlation between tenting area or height and cumulative cabergoline dose.. We found no evidence of increased mitral valve tenting area/height, valvular thickening or significant regurgitation with the long-term administration of the commonly used doses of cabergoline to treat prolactinoma.

Topics: Aortic Valve Insufficiency; Cabergoline; Calcinosis; Echocardiography; Ergolines; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Prolactinoma; Ventricular Dysfunction, Left

Treatment with ergot-derived dopamine agonists, pergolide, and cabergoline has been associated with an increased frequency of valvular heart disease in Parkinson's disease. The aim of the present study was to assess the prevalence of valvular heart disease in patients treated with dopamine agonists for prolactinomas.. This was a cross-sectional study.. We performed two-dimensional and Doppler echocardiography in 78 consecutive patients with prolactinoma (mean age 47 +/- 1.4 yr, 26% male, 31% macroprolactinoma) treated with dopamine agonists for at least 1 yr (mean 8 +/- 0.6 yr) and 78 control subjects. Patients were classified according to treatment: patients treated with cabergoline (group 1: n = 47) and patients not treated with cabergoline (group 2: n = 31).. Clinically relevant valvular heart disease was present in 12% of patients (nine of 78) vs. 17% of controls (13 of 78) (P = 0.141) and 17% (eight of 47) of patients treated with cabergoline vs. 3% (one of 31) of patients not treated with cabergoline (P = 0.062). Mild tricuspid regurgitation was present in 41% of patients vs. 26% of controls (P = 0.042), and aortic valve calcification was present in 40% of patients, compared with 18% of controls (P = 0.003). There was no relation between the cumulative dose of cabergoline and the presence of mild, moderate, or severe valve regurgitation.. Several years of dopamine agonist treatment in patients with prolactinomas is associated with increased prevalence of aortic valve calcification and mild tricuspid regurgitation but not with clinically relevant valvular heart disease. Therefore, additional studies on the adverse cardiac effects of dopaminergic drugs in prolactinoma are warranted, especially in patients with much longer use of these drugs.

Topics: Adult; Aortic Valve; Cabergoline; Calcinosis; Case-Control Studies; Cross-Sectional Studies; Disease Progression; Dopamine Agonists; Ergolines; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Pituitary Neoplasms; Prevalence; Prolactinoma; Time Factors; Tricuspid Valve Insufficiency