C E Stiles1,2, E T Tetteh-Wayoe1, J Bestwick3, R P Steeds4,5, W M Drake2. 1. Queen Mary University of London, Department of Endocrinology, London. 2. Department of Endocrinology, St Bartholomew's Hospital, London. 3. Queen Mary University of London, Centre for Environmental and Preventive Medicine, London. 4. Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham. 5. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham.
Abstract
CONTEXT: Cabergoline is first line treatment for most patients with lactotrope pituitary tumors and hyperprolactinemia. Its use at high-dose in Parkinson's disease has largely been abandoned, because of its association with the development of a characteristic restrictive cardiac valvulopathy. Whether similar valvular changes occur in patients receiving lower doses for treatment of hyperprolactinemia is unclear, although stringent regulatory recommendations for echocardiographic screening exist. OBJECTIVE: To conduct a meta-analysis exploring any link between the use of cabergoline for the treatment of hyperprolactinemia and clinically-significant cardiac valvulopathy. DATA SOURCES: Full-text papers published up to and including January 2017 were found via PubMed and selected according to strict inclusion criteria. STUDY SELECTION: All case-control studies were included where patients had received ≥6 months cabergoline treatment for hyperprolactinemia. Single case reports, previous meta-analyses, review papers and papers pertaining solely to Parkinson's disease were excluded. 13/76 originally selected studies met inclusion criteria. DATA EXTRACTION: A list of desired data were compiled and extracted from papers by independent observers. Each also independently graded for paper quality (bias) and met to reach consensus. DATA SYNTHESIS: More tricuspid regurgitation was observed (OR 3.74; 95% CI 1.79-7.8 p<0.001) in the cabergoline treated patients compared to controls. In no patient was tricuspid valve dysfunction diagnosed as a result of clinical symptoms. There was no significant increase in any other valvulopathy. CONCLUSIONS: Treatment with low dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this is unclear and requires further investigation. 51.
CONTEXT: Cabergoline is first line treatment for most patients with lactotrope pituitary tumors and hyperprolactinemia. Its use at high-dose in Parkinson's disease has largely been abandoned, because of its association with the development of a characteristic restrictive cardiac valvulopathy. Whether similar valvular changes occur in patients receiving lower doses for treatment of hyperprolactinemia is unclear, although stringent regulatory recommendations for echocardiographic screening exist. OBJECTIVE: To conduct a meta-analysis exploring any link between the use of cabergoline for the treatment of hyperprolactinemia and clinically-significant cardiac valvulopathy. DATA SOURCES: Full-text papers published up to and including January 2017 were found via PubMed and selected according to strict inclusion criteria. STUDY SELECTION: All case-control studies were included where patients had received ≥6 months cabergoline treatment for hyperprolactinemia. Single case reports, previous meta-analyses, review papers and papers pertaining solely to Parkinson's disease were excluded. 13/76 originally selected studies met inclusion criteria. DATA EXTRACTION: A list of desired data were compiled and extracted from papers by independent observers. Each also independently graded for paper quality (bias) and met to reach consensus. DATA SYNTHESIS: More tricuspid regurgitation was observed (OR 3.74; 95% CI 1.79-7.8 p<0.001) in the cabergoline treated patients compared to controls. In no patient was tricuspid valve dysfunction diagnosed as a result of clinical symptoms. There was no significant increase in any other valvulopathy. CONCLUSIONS: Treatment with low dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this is unclear and requires further investigation. 51.
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: Renato Cozzi; Maria Rosaria Ambrosio; Roberto Attanasio; Claudia Battista; Alessandro Bozzao; Marco Caputo; Enrica Ciccarelli; Laura De Marinis; Ernesto De Menis; Marco Faustini Fustini; Franco Grimaldi; Andrea Lania; Giovanni Lasio; Francesco Logoluso; Marco Losa; Pietro Maffei; Davide Milani; Maurizio Poggi; Michele Zini; Laurence Katznelson; Anton Luger; Catalina Poiana Journal: Eur J Endocrinol Date: 2022-02-03 Impact factor: 6.664
Authors: W A Bashari; M van der Meulen; J MacFarlane; D Gillett; R Senanayake; L Serban; A S Powlson; A M Brooke; D J Scoffings; J Jones; D G O'Donovan; J Tysome; T Santarius; N Donnelly; I Boros; F Aigbirhio; S Jefferies; H K Cheow; I A Mendichovszky; A G Kolias; R Mannion; O Koulouri; M Gurnell Journal: Pituitary Date: 2022-05-24 Impact factor: 3.599
Authors: L Andereggen; J Frey; R H Andres; M M Luedi; M El-Koussy; H R Widmer; J Beck; L Mariani; R W Seiler; E Christ Journal: J Endocrinol Invest Date: 2021-04-13 Impact factor: 4.256