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A comparison of cabergoline and bromocriptine on the risk of valvular heart disease in patients with prolactinomas

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Abstract

Therapy with dopamine agonists has been associated with valvular heart disease (VHD) in Parkinson’s disease, raising concern about the safety of these drugs. In hyperprolactinemic patients, the studies have mainly focused on the cardiac effects of cabergoline (CBG), with little information on bromocriptine (BRC). The aim of the present study was to evaluate the prevalence of VHD in patients with prolactinomas treated with CBG and BRC. The CBG group consisted of 51 patients (37 female; age 42.3 ± 13.5 years) who had been taking CBG for at least 1 year (mean 37.8 ± 21.3 months; cumulative doses 16–1,286.8 mg). The BRC group consisted of 19 patients (14 female; age 41.8 ± 11.5 years) who were on BRC for at least 1 year (mean 54.8 ± 30.2 months; cumulative doses 4,687.5–23,478.8 mg). The controls (CTR) were 59 healthy subjects matched for age, sex, and prevalence of arterial hypertension. Participants were subjected to transthoracic echocardiography and the valvular regurgitation was graduated as absent (grade 0), trace (1), mild (2), moderate (3) or severe (4). Compared to CTR, trace mitral (Mi) regurgitation (49% vs. 27.1%; P = 0.02), trace tricuspid (Tri) regurgitation (45.1% vs. 20.3%; P = 0.0003) and mild Tri regurgitation (7.8% vs. 0%; P = 0.0003) were more prevalent with CBG, while trace Tri regurgitation (73.7% vs. 20.3%; P = 0.0004) were more prevalent with BRC. Mitral tenting area was significantly higher in CBG than in BRC and CTR. None of the valvar abnormalities was associated with symptoms. In conclusion, patients with prolactinomas treated with either CBG or BRC showed higher prevalence of trace and mild Tri or Mi regurgitation, but these findings were not clinically significant.

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References

  1. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A (2006) Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65:265–273

    Article  Google Scholar 

  2. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine Society (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:273–288

    Article  PubMed  CAS  Google Scholar 

  3. Dos Santos Nunes V, El Dib R, Boguszewski CL, Nogueira CR (2011) Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and meta-analysis. Pituitary 14:259–265

    Article  PubMed  Google Scholar 

  4. Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356:39–46

    Article  PubMed  CAS  Google Scholar 

  5. Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007) Dopamine agonists and the risk of cardiac-valve regurgitation. N Engl J Med 356:29–38

    Article  PubMed  CAS  Google Scholar 

  6. Roth BL (2007) Drugs and valvular heart disease. N Engl J Med 356:6–9

    Article  PubMed  CAS  Google Scholar 

  7. Valassi E, Klibanski A, Biller BM (2010) Potential cardiac valve effects of dopamine agonists in hyperprolactinemia. J Clin Endocrinol Metab 95:1025–1033

    Article  PubMed  CAS  Google Scholar 

  8. Serratrice J, Disdier P, Habib G, Viallet F, Weiller P (2002) Fibrotic valvular heart disease subsequent to bromocriptine treatment. Cardiol Rev 10:334–336

    Article  PubMed  Google Scholar 

  9. Tan LC, Ng KK, Au WL, Lee RK, Chan YH, Tan NC (2009) Bromocriptine use and the risk of valvular heart disease. Mov Disord 24:344–349

    Article  PubMed  Google Scholar 

  10. Devereux RB, Casale PN, Kligfield P, Eisenberg RR, Miller D, Campo E, Alonso DR (1986) Performance of primary and derived M-mode echocardiographic measurements for detection of left ventricular hypertrophy in necropsied subjects and in patients with systemic hypertension, mitral regurgitation and dilated cardiomyopathy. Am J Cardiol 57:1388–1393

    Article  PubMed  CAS  Google Scholar 

  11. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of Echocardiography (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802

    Article  PubMed  Google Scholar 

  12. Wakil A, Rigby AS, Clark AL, Kallvikbacka-Bennett A, Atkin SL (2008) Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease. Eur J Endocrinol 159:R11–R14

    Article  PubMed  CAS  Google Scholar 

  13. Devin JK, Lakhani VT, Byrd BF 3rd, Blevins LS Jr (2008) Prevalence of valvular heart disease in a cohort of patients taking cabergoline for management of hyperprolactinemia. Endocr Pract 14:672–677

    PubMed  Google Scholar 

  14. Herring N, Szmigielski C, Becher H, Karavitaki N, Wass JA (2009) Valvular heart disease and the use of cabergoline for the treatment of prolactinoma. Clin Endocrinol (Oxf) 70:104–108

    Article  Google Scholar 

  15. Nachtigall LB, Valassi E, Lo J, McCarty D, Passeri J, Biller BM, Miller KK, Utz A, Grinspoon S, Lawson EA, Klibanski A (2010) Gender effects on cardiac valvular function in hyperprolactinaemic patients receiving cabergoline: a retrospective study. Clin Endocrinol (Oxf) 72:53–58

    Article  CAS  Google Scholar 

  16. Bogazzi F, Buralli S, Manetti L, Raffaelli V, Cigni T, Lombardi M, Boresi F, Taddei S, Salvetti A, Martino E (2008) Treatment with low doses of cabergoline is not associated with increased prevalence of cardiac valve regurgitation in patients with hyperprolactinaemia. Int J Clin Pract 62:1864–1869

    Article  PubMed  CAS  Google Scholar 

  17. Kars M, Delgado V, Holman ER, Feelders RA, Smit JW, Romijn JA, Bax JJ, Pereira AM (2008) Aortic valve calcification and mild tricuspid regurgitation but no clinical heart disease after 8 years of dopamine agonist therapy for prolactinoma. J Clin Endocrinol Metab 93:3348–3356

    Article  PubMed  CAS  Google Scholar 

  18. Lancellotti P, Livadariu E, Markov M, Daly AF, Burlacu MC, Betea D, Pierard L, Beckers A (2008) Cabergoline and the risk of valvular lesions in endocrine disease. Eur J Endocrinol 159:1–5

    Article  PubMed  CAS  Google Scholar 

  19. Vallette S, Serri K, Rivera J, Santagata P, Delorme S, Garfield N, Kahtani N, Beauregard H, Aris-Jilwan N, Houde G, Serri O (2009) Long-term cabergoline therapy is not associated with valvular heart disease in patients with prolactinomas. Pituitary 12:153–157

    Article  PubMed  CAS  Google Scholar 

  20. Colao A, Galderisi M, Di Sarno A, Pardo M, Gaccione M, D’Andrea M, Guerra E, Pivonello R, Lerro G, Lombardi G (2008) Increased prevalence of tricuspid regurgitation in patients with prolactinomas chronically treated with cabergoline. J Clin Endocrinol Metab 93:3777–3784

    Article  PubMed  CAS  Google Scholar 

  21. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999) Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 83:897–902

    Article  PubMed  CAS  Google Scholar 

  22. Peralta C, Wolf E, Alber H, Seppi K, Müller S, Bösch S, Wenning GK, Pachinger O, Poewe W (2006) Valvular heart disease in Parkinson’s disease vs. controls: an echocardiographic study. Mov Disord 21:1109–1113

    Article  PubMed  Google Scholar 

  23. Yamamoto M, Uesugi T, Nakayama T (2006) Dopamine agonists and cardiac valvulopathy in Parkinson disease: a case-control study. Neurology 67:1225–1229

    Article  PubMed  CAS  Google Scholar 

  24. Junghanns S, Fuhrmann JT, Simonis G, Oelwein C, Koch R, Strasser RH, Reichmann H, Storch A (2007) Valvular heart disease in Parkinson’s disease patients treated with dopamine agonists: a reader-blinded monocenter echocardiography study. Mov Disord 22:234–238

    Article  PubMed  Google Scholar 

  25. Kenangil G, Ozekmekçi S, Koldas L, Sahin T, Erginöz E (2007) Assessment of valvulopathy in Parkinson’s disease patients on pergolide and/or cabergoline. Clin Neurol Neurosurg 109:350–353

    Article  PubMed  Google Scholar 

  26. Rasmussen VG, Poulsen SH, Dupont E, Østergaard K, Safikhany G, Egeblad H (2008) Heart valve disease associated with treatment with ergot-derived dopamine agonists: a clinical and echocardiographic study of patients with Parkinson’s disease. J Intern Med 263:90–98

    PubMed  CAS  Google Scholar 

  27. Yamashiro K, Komine-Kobayashi M, Hatano T, Urabe T, Mochizuki H, Hattori N, Iwama Y, Daida H, Sakai M, Nakayama T, Mizuno Y (2008) The frequency of cardiac valvular regurgitation in Parkinson’s disease. Mov Disord 23:935–941

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors of the present study have no conflict of interest to declare.

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Authors and Affiliations

  1. SEMPR, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas, Department of Internal Medicine, Federal University of Parana, Avenida Agostinho Leao Junior, 285, Curitiba, PR, 80030-110, Brazil

    Cesar Luiz Boguszewski, Carlos Mauricio Correa dos Santos, Kelly Suga Sakamoto & Lilian Cassia Marini

  2. Serviço de Ecocardiografia do Hospital de Clínicas, Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, PR, Brazil

    Admar Moraes de Souza

  3. Serviço de Endocrinologia, Universidade de Brasília, Brasilia, DF, Brazil

    Monalisa Azevedo

Authors
  1. Cesar Luiz Boguszewski
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  2. Carlos Mauricio Correa dos Santos
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  3. Kelly Suga Sakamoto
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  4. Lilian Cassia Marini
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  5. Admar Moraes de Souza
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Correspondence to Cesar Luiz Boguszewski.

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Boguszewski, C.L., dos Santos, C.M.C., Sakamoto, K.S. et al. A comparison of cabergoline and bromocriptine on the risk of valvular heart disease in patients with prolactinomas. Pituitary 15, 44–49 (2012). https://doi.org/10.1007/s11102-011-0339-7

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  • DOI: https://doi.org/10.1007/s11102-011-0339-7

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