William M Drake1, Craig E Stiles1, John S Bevan1, Niki Karavitaki1, Peter J Trainer1, D Aled Rees1, Tristan I Richardson1, Stephanie E Baldeweg1, Nemanja Stojanovic1, Robert D Murray1, Andrew A Toogood1, Niamh M Martin1, Bijay Vaidya1, Than S Han1, Rick P Steeds1, F C Baldeweg1, U E Sheikh1, N Kyriakakis1, S K Parasuraman1, L Taylor1, N Butt1, S Anyiam1. 1. Department Endocrinology (W.M.D., C.E.S.), St Bartholomew's Hospital, London EC1A 7BE, United Kingdom; Department of Cardiology (S.K.P),JJR Macleod Centre for Diabetes, Endocrinology & Metabolism (J.S.B.), Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZP, United Kingdom; Institute of Metabolism and Systems Research (N.K.), School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Department Endocrinology (P.J.T., S.A.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; Neurosciences and Mental Health Research Institute (A.R.), School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom; Diabetes and Endocrine Centre (T.I.R., N.B.), Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, United Kingdom; Department Endocrinology (S.E.B., F.C.B.), University College London Hospital, London NW1 2BU, United Kingdom; Queen's Hospital (N.S.), Romford, Essex RM7 0AG, United Kingdom; Department of Endocrinology (R.D.M., N.K.), Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds LS9 7TF, United Kingdom; Department of Endocrinology (A.A.T.), Queen Elizabeth Hospital, University Hospitals Birmingham, NHSFT, Edgbaston, Birmingham B15 2TH, United Kingdom; Imperial Centre for Endocrinology (N.M.M.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Endocrinology (B.V., U.E.S.), Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter EX2 4TP, United Kingdom; Institute of Cardiovascular Research (T.S.H.), Royal Holloway, University of London (ICR2UL) & Ashford and St Peter's NHS Foundation Trust, Surrey TW20 0EX, United Kingdom; Department Cardiology (R.P.S., L.T.), University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom.
Abstract
CONTEXT: Uncertainty exists whether the long-term use of ergot-derived dopamine agonist (DA) drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease and whether current regulatory authority guidelines for echocardiographic screening are clinically appropriate. OBJECTIVE: Our objective was to provide follow-up echocardiographic data on a previously described cohort of patients treated with DA for lactotrope pituitary tumors and to explore possible associations between structural and functional valve abnormalities with the cumulative dose of drug used. DESIGN: Follow-up echocardiographic data were collected from a proportion of our previously reported cohort of patients; all had received continuous DA therapy for at least 2 years in the intervening period. Studies were performed according to British Society of Echocardiography minimum standards for adult transthoracic echocardiography. Generalized estimating equations with backward selection were used to determine odds ratios of valvular heart abnormalities according to tertiles of cumulative cabergoline dose, using the lowest tertile as the reference group. SETTING: Thirteen centers of secondary/tertiary endocrine care across the United Kingdom were included. RESULTS: There were 192 patients (81 males; median age, 51 years; interquartile range [IQR], 42-62). Median (IQR) cumulative cabergoline doses at the first and second echocardiograms were 97 mg (20-377) and 232 mg (91-551), respectively. Median (IQR) duration of uninterrupted cabergoline therapy between echocardiograms was 34 months (24-42). No associations were observed between cumulative doses of dopamine agonist used and the age-corrected prevalence of any valvular abnormality. CONCLUSION: This large UK follow-up study does not support a clinically significant association between the use of DA for the treatment of hyperprolactinemia and cardiac valvulopathy.
CONTEXT: Uncertainty exists whether the long-term use of ergot-derived dopamine agonist (DA) drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease and whether current regulatory authority guidelines for echocardiographic screening are clinically appropriate. OBJECTIVE: Our objective was to provide follow-up echocardiographic data on a previously described cohort of patients treated with DA for lactotrope pituitary tumors and to explore possible associations between structural and functional valve abnormalities with the cumulative dose of drug used. DESIGN: Follow-up echocardiographic data were collected from a proportion of our previously reported cohort of patients; all had received continuous DA therapy for at least 2 years in the intervening period. Studies were performed according to British Society of Echocardiography minimum standards for adult transthoracic echocardiography. Generalized estimating equations with backward selection were used to determine odds ratios of valvular heart abnormalities according to tertiles of cumulative cabergoline dose, using the lowest tertile as the reference group. SETTING: Thirteen centers of secondary/tertiary endocrine care across the United Kingdom were included. RESULTS: There were 192 patients (81 males; median age, 51 years; interquartile range [IQR], 42-62). Median (IQR) cumulative cabergoline doses at the first and second echocardiograms were 97 mg (20-377) and 232 mg (91-551), respectively. Median (IQR) duration of uninterrupted cabergoline therapy between echocardiograms was 34 months (24-42). No associations were observed between cumulative doses of dopamine agonist used and the age-corrected prevalence of any valvular abnormality. CONCLUSION: This large UK follow-up study does not support a clinically significant association between the use of DA for the treatment of hyperprolactinemia and cardiac valvulopathy.
Authors: Maria Fleseriu; Richard Auchus; Irina Bancos; Anat Ben-Shlomo; Jerome Bertherat; Nienke R Biermasz; Cesar L Boguszewski; Marcello D Bronstein; Michael Buchfelder; John D Carmichael; Felipe F Casanueva; Frederic Castinetti; Philippe Chanson; James Findling; Mônica Gadelha; Eliza B Geer; Andrea Giustina; Ashley Grossman; Mark Gurnell; Ken Ho; Adriana G Ioachimescu; Ursula B Kaiser; Niki Karavitaki; Laurence Katznelson; Daniel F Kelly; André Lacroix; Ann McCormack; Shlomo Melmed; Mark Molitch; Pietro Mortini; John Newell-Price; Lynnette Nieman; Alberto M Pereira; Stephan Petersenn; Rosario Pivonello; Hershel Raff; Martin Reincke; Roberto Salvatori; Carla Scaroni; Ilan Shimon; Constantine A Stratakis; Brooke Swearingen; Antoine Tabarin; Yutaka Takahashi; Marily Theodoropoulou; Stylianos Tsagarakis; Elena Valassi; Elena V Varlamov; Greisa Vila; John Wass; Susan M Webb; Maria C Zatelli; Beverly M K Biller Journal: Lancet Diabetes Endocrinol Date: 2021-10-20 Impact factor: 32.069
Authors: Craig Edward Stiles; Guy Lloyd; Sanjeev Bhattacharyya; Richard Paul Steeds; Kambiz Boomla; Jonathan Paul Bestwick; William Martyn Drake Journal: J Clin Endocrinol Metab Date: 2021-01-23 Impact factor: 5.958
Authors: Aditya John Binu; Kripa Elizabeth Cherian; Nitin Kapoor; Sujith Thomas Chacko; Oommen George; Thomas Vizhalil Paul Journal: Indian J Endocrinol Metab Date: 2017 Nov-Dec