In 2007, cabergoline use was linked to significant cardiac valve abnormalities in patients with Parkinson’s disease. Cabergoline is also used as first line treatment for prolactinoma. The product information recommends echocardiogram at baseline and then every 6-12 months. The literature reports 781 cases of prolactinoma taking cabergoline who have undergone echocardiograms compared to controls. No study has looked at the value of a clinical cardiovascular examination as an initial screening procedure.
Aim:
To compare the findings on clinical cardiovascular examination with transthoracic echocardiography in patients with prolactinoma treated with cabergoline for >1 year.
Methods:
40 consecutive cases (48% female, mean age 39.6 yrs, 52% males, mean age 48.9 yrs) underwent cardiovascular examination by their treating endocrinologist during a routine clinic visit, followed by echocardiogram at a single centre.
Results:
The duration of cabergoline therapy 71.2 months (range 50-92) and cumulative cabergoline dose: 389±169 mg (females), 393±55 mg (males). Comorbidities included hypertension 10%, diabetes 5% and hyperlipidaemia 5%. One case reported symptoms of dyspnoea on extreme exertion.
Cardiovascular examination:
4/40 (10%) had an audible systolic murmur, all graded 2/6 with normal heart sounds. 4/40 (10%) were hypertensive (≥150/90 mmHg), 6/40 (15%) hypotensive (<100 mmHg systolic).
Echocardiogram findings:
No cases of fibrotic valvular thickening were identified. No moderate-severe valvular lesions were found. There were four cases of age related aortic sclerosis and two cases of myxomatous disease of the mitral valve. The 4 cases with an audible murmur did not have valvular abnormalities.
Conclusion:
This study further confirms that cabergoline in doses used for prolactinoma is rarely associated with clinical relevant valvular disease. Echocardiogram is not required as a routine screening tool in all patients. We suggest targeting those with an audible murmur on clinical examination, high doses of cabergoline and patients at higher background risk of valvular abnormalities (based on age and co-morbidities).