Skip to main content
Download PDF

Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology

Echo Research & Practice volume 6, pages G1–G8 (2019)Cite this article

Abstract

This is a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology on the role of echocardiography in monitoring patients receiving dopamine agonist (DA) therapy for hyperprolactinaemia. (1) Evidence that DA pharmacotherapy causes abnormal valve morphology and dysfunction at doses used in the management of hyperprolactinaemia is extremely limited. Evidence of clinically significant valve pathology is absent, except for isolated case reports around which questions remain. (2) Attributing change in degree of valvular regurgitation, especially in mild and moderate tricuspid regurgitation, to adverse effects of DA in hyperprolactinaemia should be avoided if there are no associated pathological changes in leaflet thickness, restriction or retraction. It must be noted that even where morphological change in leaflet structure and function may be suspected, grading is semi-quantitative on echocardiography and may vary between different machines, ultrasound settings and operators. (3) Decisions regarding discontinuation of medication should only be made after review of serial imaging by an echocardiographer experienced in analysing drug-induced valvulopathy or carcinoid heart disease. (4) A standard transthoracic echocardiogram should be performed before a patient starts DA therapy for hyperprolactinaemia. Repeat transthoracic echocardiography should then be performed at 5 years after starting cabergoline in patients taking a total weekly dose less than or equal to 2 mg. If there has been no change on the 5-year scan, repeat echocardiography could continue at 5-yearly intervals. If a patient is taking more than a total weekly dose of 2 mg, then annual echocardiography is recommended.

References

  1. Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E. Dopamine agonists and the risk of cardiac-valve regurgitation. New England Journal of Medicine 2007 356 29–38. (https://doi.org/10.1056/NEJMoa062222)

    CAS  Google Scholar 

  2. Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G. Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. New England Journal of Medicine 2007 356 39–46. (https://doi.org/10.1056/NEJMoa054830)

    CAS  Google Scholar 

  3. Van Camp G, Flamez A, Cosyns B, Weytjens C, Muyldermans L, Van Zandijcke M, De Sutter J, Santens P, Decoodt P, Moerman C, et al. Treatment of Parkinson’s disease with pergolide and relation to restrictive valvular heart disease. Lancet 2004 363 1179–1183. (https://doi.org/10.1016/S0140-6736(04)15945-X)

    PubMed  Google Scholar 

  4. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clinical Endocrinology 2006 65 265–273. (https://doi.org/10.1111/j.1365-2265.2006.02562.x)

    PubMed  Google Scholar 

  5. Drake WM, Stiles CE, Bevan JS, Karavitaki N, Trainer PJ, Rees DA, Richardson TI, Baldeweg SE, Stojanovic N, Murray RD, et al. A follow-up study of the prevalence of valvular heart abnormalities in hyperprolactinemic patients treated with cabergoline. Journal of Clinical Endocrinology and Metabolism 2016 101 4189–4194. (https://doi.org/10.1210/jc.2016-2224)

    CAS  PubMed  Google Scholar 

  6. Elangbam CS. Drug-induced valvulopathy: an update. Toxicologic Pathology 2010 38 837–848. (https://doi.org/10.1177/0192623310378027)

    CAS  PubMed  Google Scholar 

  7. Pinero A, Marcos-Alberca P, Fortes J. Cabergoline-related severe restrictive mitral regurgitation. New England Journal of Medicine 2005 353 1976–1977. (https://doi.org/10.1056/NEJM200511033531822)

    CAS  Google Scholar 

  8. Gu H, Luck S, Carroll PV, Powrie J, Chambers J. Cardiac valve disease and low-dose dopamine agonist therapy: an artefact of reporting bias? Clinical Endocrinology 2011 74 608–610. (https://doi.org/10.1111/j.1365-2265.2010.03973.x)

    CAS  PubMed  Google Scholar 

  9. d’Arcy JL, Coffey S, Loudon MA, Kennedy A, Pearson-Stuttard J, Birks J, Frangou E, Farmer AJ, Mant D, Wilson J, et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study. European Heart Journal 2016 37 3515–3522. (https://doi.org/10.1093/eurheartj/ehw229)

    PubMed  PubMed Central  Google Scholar 

  10. Bogazzi F, Buralli S, Manetti L, Raffaelli V, Cigni T, Lombardi M, Boresi F, Taddei S, Salvetti A, Martino E. Treatment with low doses of cabergoline is not associated with increased prevalence of cardiac valve regurgitation in patients with hyperprolactinaemia. International Journal of Clinical Practice 2008 62 1864–1869. (https://doi.org/10.1111/j.1742-1241.2008.01779.x)

    CAS  PubMed  Google Scholar 

  11. Colao A, Galderisi M, Di Sarno A, Pardo M, Gaccione M, D’Andrea M, Guerra E, Pivonello R, Lerro G, Lombardi G. Increased prevalence of tricuspid regurgitation in patients with prolactinomas chronically treated with cabergoline. Journal of Clinical Endocrinology and Metabolism 2008 93 3777–3784. (https://doi.org/10.1210/jc.2007-1403)

    CAS  PubMed  Google Scholar 

  12. Kars M, Delgado V, Holman ER, Feelders RA, Smit JWA, Romijn JA, Bax JJ, Pereira AM. Aortic valve calcification and mild tricuspid regurgitation but no clinical heart disease after 8 years of dopamine agonist therapy for prolactinoma. Journal of Clinical Endocrinology and Metabolism 2008 93 3348–3356. (https://doi.org/10.1210/jc.2007-2658)

    CAS  PubMed  Google Scholar 

  13. Lancellotti P, Livadariu E, Markov M, Daly AF, Burlacu MC, Betea D, Pierard L, Beckers A. Cabergoline and the risk of valvular lesions in endocrine disease. European Journal of Endocrinology 2008 159 1–5. (https://doi.org/10.1530/EJE-08-0213)

    CAS  PubMed  Google Scholar 

  14. Wakil A, Rigby AS, Clark AL, Kallvikbacka-Bennett A, Atkin SL. Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease. European Journal of Endocrinology 2008 159 R11–R14. (https://doi.org/10.1530/EJE-08-0365)

    CAS  PubMed  Google Scholar 

  15. Tan T, Cabrita IZ, Hensman D, Grogono J, Dhillo WS, Baynes KC, Eliahoo J, Meeran K, Robinson S, Nihoyannopoulos P, et al. Assessment of cardiac valve dysfunction in patients receiving cabergoline treatment for hyperprolactinaemia. Clinical Endocrinology 2010 73 369–374. (https://doi.org/10.1111/j.1365-2265.2010.03827.x)

    CAS  PubMed  Google Scholar 

  16. Vallette S, Serri K, Rivera J, Santagata P, Delorme S, Garfield N, Kahtani N, Beauregard H, Aris-Jilwan N, Houde G, et al. Long-term cabergoline therapy is not associated with valvular heart disease in patients with prolactinomas. Pituitary 2009 12 153–157. (https://doi.org/10.1007/s11102-008-0134-2)

    CAS  PubMed  Google Scholar 

  17. Elenkova A, Shabani R, Kalinov K, Zacharieva S. Increased prevalence of subclinical cardiac valve fibrosis in patients with prolactinomas on long-term bromocriptine and cabergoline treatment. European Journal of Endocrinology 2012 167 17–25. (https://doi.org/10.1530/EJE-12-0121)

    CAS  PubMed  Google Scholar 

  18. Herring N, Szmigielski C, Becher H, Karavitaki N, Wass JAH. Valvular heart disease and the use of cabergoline for the treatment of prolactinoma. Clinical Endocrinology 2009 70 104–108. (https://doi.org/10.1111/j.1365-2265.2008.03458.x)

    PubMed  Google Scholar 

  19. Lafeber M, Stades AM, Valk GD, Cramer MJ, Teding van Berkhout F, Zelissen PM. Absence of major fibrotic adverse events in hyperprolactinemic patients treated with cabergoline. European Journal of Endocrinology 2010 162 667–675. (https://doi.org/10.1530/EJE-09-0989)

    CAS  PubMed  Google Scholar 

  20. Nachtigall LB, Valassi E, Lo J, McCarty D, Passeri J, Biller BMK, Miller KK, Utz A, Grinspoon S, Lawson EA, et al. Gender effects on cardiac valvular function in hyperprolactinaemic patients receiving cabergoline: a retrospective study. Clinical Endocrinology 2010 72 53–58. (https://doi.org/10.1111/j.1365-2265.2009.03608.x)

    CAS  PubMed  Google Scholar 

  21. Boguszewski CL, dos Santos CMC, Sakamoto KS, Marini LC, de Souza AM, Azevedo M. A comparison of cabergoline and bromocriptine on the risk of valvular heart disease in patients with prolactinomas. Pituitary 2012 15 44–49. (https://doi.org/10.1007/s11102-011-0339-7)

    CAS  PubMed  Google Scholar 

  22. Doğan BA, Arduc A, Tuna MM, Berker D, Demirci N, Demirtaş S, Çiçekcioğlu H, Güler S. Autoimmune fibrotic adverse reactions in one-year treatment with cabergoline for women with prolactinoma. Endocrine, Metabolic and Immune Disorders 2016 16 47–55. (https://doi.org/10.2174/1871530316666160229120142)

    Google Scholar 

  23. Córdoba-Soriano JG, Lamas-Oliveira C, Hidalgo-Olivares VM, Tercero-Martínez A, Barambio-Ruíz M, Salas-Nieto J. Valvular heart disease in hyperprolactinemic patients treated with low doses of cabergoline. Revista Española de Cardiología 2013 66 410–412. (https://doi.org/10.1016/j.rec.2012.10.016)

    PubMed  Google Scholar 

  24. Drake WM, Stiles CE, Howlett TA, Toogood AA, Bevan JS, Steeds RP. A cross-sectional study of the prevalence of cardiac valvular abnormalities in hyperprolactinemic patients treated with ergot-derived dopamine agonists. Journal of Clinical Endocrinology and Metabolism 2014 99 90–96. (https://doi.org/10.1210/jc.2013-2254)

    CAS  PubMed  Google Scholar 

  25. D’Aloia A, Piovanelli B, Rovetta R, Bonadei I, Vizzardi E, Curnis A, Metra M. A case of iatrogenic severe mitral regurgitation. Monaldi Archives for Chest Disease 2013 80 133–136. (https://doi.org/10.4081/monaldi.2013.75)

    PubMed  Google Scholar 

  26. Izgi C, Feray H, Cevik C, Saltan Y, Mansuroglu D, Nugent K. Severe tricuspid regurgitation in a patient receiving low-dose cabergoline for the treatment of acromegaly. Journal of Heart Valve Disease 2010 19 797–800.

    Google Scholar 

  27. Cawood TJ, Bridgman P, Hunter L, Cole D. Low-dose cabergoline causing valvular heart disease in a patient treated for prolactinoma. Internal Medicine Journal 2009 39 266–267. (https://doi.org/10.1111/j.1445-5994.2009.01920.x)

    CAS  PubMed  Google Scholar 

  28. Delgado V, Biermasz NR, van Thiel SW, Ewe SH, Marsan NA, Holman ER, Feelders RA, Smit JW, Bax JJ, Pereira AM. Changes in heart valve structure and function in patients treated with dopamine agonists for prolactinomas, a 2-year follow-up study. Clinical Endocrinology 2012 77 99–105. (https://doi.org/10.1111/j.1365-2265.2011.04326.x)

    CAS  PubMed  Google Scholar 

  29. Vroonen L, Lancellotti P, Garcia MT, Dulgheru R, Rubio-Almanza M, Maiga I, Magne J, Petrossians P, Auriemma R, Daly AF, et al. Prospective, long-term study of the effect of cabergoline on valvular status in patients with prolactinoma and idiopathic hyperprolactinemia. Endocrine 2017 55 239–245. (https://doi.org/10.1007/s12020-016-1120-5)

    CAS  PubMed  Google Scholar 

  30. De Vecchis R, Esposito C, Ariano C. Cabergoline use and risk of fibrosis and insufficiency of cardiac valves. Meta-analysis of observational studies. Herz 2013 38 868–880. (https://doi.org/10.1007/s00059-013-3816-0)

    PubMed  Google Scholar 

  31. Bogazzi F, Manetti L, Raffaelli V, Lombardi M, Rossi G, Martino E. Cabergoline therapy and the risk of cardiac valve regurgitation in patients with hyperprolactinemia: a metaanalysis from clinical studies. Journal of Endocrinological Investigation 2008 31 1119–1123. (https://doi.org/10.1007/BF03345662)

    CAS  PubMed  Google Scholar 

  32. Stiles CE, Tetteh-Wayoe ET, Bestwick J, Steeds RP, Drake WM. A meta-analysis of the incidence of cardiac valvulopathy in hyperprolactinemic patients treated with cabergoline. Journal of Clinical Endocrinology and Metabolism 2018 104 523–538. (https://doi.org/10.1210/jc.2018-01071)

    Google Scholar 

  33. Gamble D, Fairley R, Harvey R, Farman C, Cantley N, Leslie SJ. Screening for valve disease in patients with hyperprolactinaemia disorders prescribed cabergoline: a service evaluation and literature review. Therapeutic Advances in Drug Safety 2017 8 215–229. (https://doi.org/10.1177/2042098617703647)

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. European Heart Journal 2017 38 2739–2791. (https://doi.org/10.1093/eurheartj/ehx391)

    PubMed  Google Scholar 

  35. Monaghan M. Training in echocardiography. Heart 1994 71 (4 Supplement) 2–5. (https://doi.org/10.1136/hrt.71.4_Suppl.2)

    Google Scholar 

  36. Wharton G, Steeds R, Allen J, Phillips H, Jones R, Kanagala P, Lloyd G, Masani N, Mathew T, Oxborough D, et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2015 2 G9–G24. (https://doi.org/10.1530/ERP-14-0079)

    PubMed  PubMed Central  Google Scholar 

  37. Dobson R, Cuthbertson DJ, Jones J, Valle JW, Keevil B, Chadwick C, Poston GP, Burgess MI. Determination of the optimal echocardiographic scoring system to quantify carcinoid heart disease. Neuroendocrinology 2014 99 85–93. (https://doi.org/10.1159/000360767)

    CAS  PubMed  Google Scholar 

  38. Bhattacharyya S, Toumpanakis C, Caplin ME, Davar J. Usefulness of N-terminal pro-brain natriuretic peptide as a biomarker of the presence of carcinoid heart disease. American Journal of Cardiology 2008 102 938–942. (https://doi.org/10.1016/j.amjcard.2008.05.047)

    CAS  Google Scholar 

  39. Caputo C, Prior D, Inder WJ. The need for annual echocardiography to detect cabergoline-associated valvulopathy in patients with prolactinoma: a systematic review and additional clinical data. Lancet Diabetes and Endocrinology 2015 3 906–913. (https://doi.org/10.1016/S2213-8587(14)70212-8)

    CAS  PubMed  Google Scholar 

  40. Halperin I, Aller J, Varela C, Mora M, Abad A, Doltra A, Santos AE, Batista E, García-Pavía P, Sitges M, et al. No clinically significant valvular regurgitation in long-term cabergoline treatment for prolactinoma. Clinical Endocrinology 2012 77 275–280. (https://doi.org/10.1111/j.1365-2265.2012.04349.x.)

    CAS  PubMed  Google Scholar 

  41. Auriemma RS, Pivonello R, Perone Y, Grasso LF, Ferreri L, Simeoli C, Iacuaniello D, Gasperi M & Colao A. Safety of long-term treatment with cabergoline on cardiac valve disease in patients with prolactinomas. European Journal of Endocrinology 2013 169 359–366. (https://doi.org/10.1530/eje-13-0231)

    CAS  PubMed  Google Scholar 

Download references

Funding

This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. University Hospital Birmingham, Birmingham, UK

    Richard P. Steeds MA FRCP MD

  2. Institute of Cardiology, University of Birmingham, Birmingham, UK

    Richard P. Steeds MA FRCP MD

  3. Department of Endocrinology, Saint Bartholomew’s Hospital, London, UK

    Craig E. Stiles MRCP PhD

  4. Department of Cardiology, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK

    Vishal Sharma MD

  5. Cardiothoracic Centre, Guy’s and St Thomas’ Hospitals–, London, UK

    John B. Chambers MD FRCP

  6. Department of Cardiology, Saint Bartholomew’s Hospital, London, UK

    Guy Lloyd MD FRCP

  7. Department of Endocrinology, Bartholomew’s Hospital, London, UK

    William Drake DM FRCP

Authors
  1. Richard P. Steeds MA FRCP MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Craig E. Stiles MRCP PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vishal Sharma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John B. Chambers MD FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guy Lloyd MD FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William Drake DM FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard P. Steeds MA FRCP MD.

Additional information

This position statement has been externally peer-reviewed. This article is simultaneously published in Echo Research and Practice and Clinical Endocrinology

R Steeds, V Sharma, J Chambers and G Lloyd are members of the editorial board of Echo Research and Practice. They were not involved in the review or editorial process for this article, on which they are listed as authors.

(V Sharma is the Guidelines Chair)

Rights and permissions

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steeds, R.P., Stiles, C.E., Sharma, V. et al. Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology. Echo Res Pract 6, G1–G8 (2019). https://doi.org/10.1530/ERP-18-0069

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-18-0069

Key Words

  • dopamine agonist
  • transthoracic echocardiography
  • hyperprolactinaemia
  • monitoring
  • valve disease

Echo Research & Practice

ISSN: 2055-0464