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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.

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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
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  2. Craig E. Stiles MRCP PhD
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  3. Vishal Sharma MD
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  4. John B. Chambers MD FRCP
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  5. Guy Lloyd MD FRCP
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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)

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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

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