Increased Prevalence of Tricuspid Regurgitation in Patients with Prolactinomas Chronically Treated with Cabergoline

Colao, Annamaria; Galderisi, Maurizio; Sarno, Antonella Di; Pardo, M.; Gaccione, Maria; D’Andrea, Marianna; Guerra, Ermelinda; Pivonello, Rosario; Lerro, Giuseppe; Lombardi, Gaetano

doi:10.1210/jc.2007-1403

Cited by 156 publications

(147 citation statements)

References 37 publications

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“…Subsequently, there were several studies addressing the risk of valvar damage in prolactinoma and acromegaly patients, without clear evidence of clinically significant valvar disease [12,[40][41][42]. The majority of the studies evaluated patients treated for hyperprolactinemia, and the follow-up times were short to assure that CAB was not associated with a risk for valvar disease in the doses used in acromegaly treatment [40,41,43,44]. In addition, acromegaly itself is associated with valvar disease [45][46][47], and there are some anecdotal reports of valvar damage associated with CAB therapy in acromegaly [48].…”

Section: Side Effectsmentioning

confidence: 99%

Cabergoline treatment in acromegaly: cons

Kasuki

Neto

2014

Endocrine

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Many options are available for the treatment of acromegaly, including surgery, radiotherapy, and medical treatment. Cabergoline (CAB), a dopamine agonist with high affinity for dopamine receptor type 2, has been used both in monotherapy and in conjunction with somatostatin analogs (SSAs). Although it is administered orally and has a relatively lower-cost in comparison with SSAs, few studies have demonstrated its usefulness, there is a lack of randomized-controlled trials and other drugs (SSAs and pegvisomant) with more data in the literature are available; these issues are the main drawbacks of adopting CAB for the treatment of acromegaly.

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Section: Side Effectsmentioning

confidence: 99%

Cabergoline treatment in acromegaly: cons

Kasuki

Neto

2014

Endocrine

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“…After the publication of the papers, which showed an increased risk of valve regurgitation after treatment with pergolide and cabergoline in patients with Parkinson's disease, six cross-sectional studies have evaluated the association between valve regurgitation and the use of cabergoline in patients treated for prolactinoma, including the study by Wakil et al published in this edition of the European Journal of Endocrinology (Table 1) (10)(11)(12)(13)(14)(15). These studies included a total of 413 patients, treated with cabergoline for 45-79 months.…”

Section: Introductionmentioning

confidence: 99%

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Kars

Pereira²,

Bax³

et al. 2008

European Journal of Endocrinology

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The increased risk of cardiac valve disease in patients treated for Parkinson's disease with cabergoline has raised concerns about the safety of treatment with ergot-derived dopamine agonists in patients with endocrine diseases, especially prolactinoma. Six cross-sectional studies have been published recently, of which five studies do not show an association between the treatment of prolactinoma with cabergoline during 45-79 months and clinically relevant valvular regurgitation in a total of 413 patients. Nonetheless, concern is raised because the use of cabergoline was associated in one study with an increased prevalence of moderate tricuspid regurgitation, and in two other studies with mild tricuspid regurgitation. Furthermore, the use of cabergoline was associated with increased frequencies of valvular thickening, calcifications and increased mitral tenting area. At present, the clinical relevance of these findings is still uncertain, but concern is raised with respect to the safety of the use of cabergoline in the long-term treatment of prolactinomas. Echocardiographic evaluation should be considered in patients, who require long-term treatment with cabergoline, especially in high doses. There is a need for larger, preferably prospective, studies with careful echocardiographic assessment and with longer durations of follow-up than the currently available studies.

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“…Cabergoline, which possesses a complete 5HT 2b agonistic activity, is the drug of choice in the treatment of prolactinomas, but the results of observational studies investigating the risk of FVHD in these patients are still controversial. Some of them have reported no relevant findings (8,9,10,11,12), five trials have observed clinically insignificant valvular changes (13,14,15,16,17), and only one study has reported an increased prevalence of moderate tricuspid regurgitation with a cumulative dose-dependent risk (18). Published data on the potential profibrotic effect of bromocriptine, a partial 5HT 2b agonist, are exclusively limited (19).…”

Section: Introductionmentioning

confidence: 99%

Transforming growth factor β1 is not a reliable biomarker for valvular fibrosis but could be a potential serum marker for invasiveness of prolactinomas (pilot study)

Еленкова¹,

Atanassova²,

Кirilov³

et al. 2013

European Journal of Endocrinology

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Background: Transforming growth factor b1 (TGFb1) signaling pathway is crucial for both human fibrogenesis and tumorigenesis. Objective: This study aimed to investigate the usefulness of TGFb1 and matrix metalloproteinase 2 (MMP2) as potential circulating markers for fibrotic valvular heart disease (FVHD) and invasiveness as well as of Fetuin A as a marker for calcification in patients with prolactinomas. Design: The study population consisted of 147 subjects divided into four groups: 30 dopamine agonist (DA)-treated prolactinoma patients with proven FVHD and three control groups with normal echocardiograms: 43 DA-treated patients, 26 naïve patients, and 48 healthy subjects. Results: We observed significantly higher serum TGFb1 levels in all three patient groups than in the healthy subjects (21.4G8.86 vs 19.1G9.03 vs 20.7G11.5 vs 15.8G7.2 ng/ml; PZ0.032). Moreover, TGFb1 levels were significantly higher in patients with macroprolactinomas and invasive prolactinomas than in those with microprolactinomas and noninvasive tumors respectively. In addition, a strong positive linear relationship between TGFb1 levels and invasiveness score (rZ0.924; P!0.001) and a moderate correlation between TGFb1 levels and tumor volume (rZ0.546; P!0.002) were observed in patients with invasive prolactinomas. By contrast, prolactin (PRL) levels exhibited a better correlation with tumor volume (rZ0.721; P!0.001) than with invasiveness score (rZ0.436; P!0.020). No significant difference was observed in Fetuin A levels between patients with FVHD and healthy controls. Results concerning MMP2 were unclear. Conclusions: TGFb1, MMP2, and Fetuin A are not reliable biomarkers for valvular fibrosis and calcification in DA-treated patients with prolactinomas, but TGFb1 may represent a useful serum marker for tumor invasiveness. The simultaneous determination of TGFb1 and PRL levels could improve the noninvasive assessment of prolactinoma behavior.

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Increased Prevalence of Tricuspid Regurgitation in Patients with Prolactinomas Chronically Treated with Cabergoline

Cited by 156 publications

References 37 publications

Cabergoline treatment in acromegaly: cons

Cabergoline treatment in acromegaly: cons

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Transforming growth factor β1 is not a reliable biomarker for valvular fibrosis but could be a potential serum marker for invasiveness of prolactinomas (pilot study)

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