OR27-6 Cardiovascular examination and echocardiography in prolactinoma patients taking cabergoline - low prevalence of valvular abnormalities

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR27-Pituitary: Acromegaly and Prolactinoma
Clinical
Sunday, June 16, 2013: 11:15 AM-12:45 PM
Presentation Start Time: 12:30 PM
Room 135 (Moscone Center)
Carmela Caputo*1, David L Prior1 and Warrick J Inder2
1St Vincent's Hospital, Melbourne, Australia, 2Princess Alexandra Hospital, Woolloongabba QLD, Australia
Background: Between 2008-12, approximately 815 cases of prolactinoma taking cabergoline have undergone echocardiograms and compared to controls. No study to date has shown an increased risk of clinically relevant valvular disease. Various authors have recommended screening all cases with echocardiograms at baseline and at least once during treatment. No study to date has looked at the value of a clinical cardiovascular examination, compared to echocardiography, as an initial screening procedure.

Aim: To compare the findings on clinical cardiovascular examination with transthoracic echocardiography in patients with prolactinoma treated with cabergoline for >1 year.

Methods: 40 consecutive cases (48% female, mean age 39.6 yrs and 52% males, mean age 48.9 yrs) of prolactinoma on cabergoline underwent cardiovascular examination by their treating endocrinologist during a routine clinic visit, followed by echocardiogram at a single centre. Transthoracic echocardiograms were undertaken on a single machine and reported unblinded by a cardiologist (DP).

Results:  28/40 (70%) cases had macroprolactinomas.  Previous bromocriptine treatment was used in 7/40 cases. Duration of cabergoline therapy of 71.2 months (range 50-92), with cumulative doses of 389±169 mg females and 393±55 mg males. Comorbidities:  hypertension 10%, diabetes 5% and hyperlipidaemia 5%. On history, only 1 case reported symptoms suggestive of cardiac disease (dyspnoea on extreme exertion).

Cardiovascular examination:  4/40 (10%) had an audible systolic murmur, all graded 2/6 with normal heart sounds. 4/40 (10%) were hypertensive (≥150/90 mmHg), 6/40 (15%) hypotensive (<100 mmHg systolic).

Echocardiogram findings: No moderate-severe valvular lesions were found. There were 4 cases of age related aortic sclerosis and 2 cases myxomatous disease of the mitral valve. No cases of fibrotic valvular thickening were identified. The 4 cases with an audible murmur did not have valvular abnormalities.

Conclusion: This study further confirms that cabergoline used for prolactinomas is rarely associated with clinical relevant valvular disease. Echocardiogram cannot be justified as a routine screening tool for valvular disease in all patients. We suggest targeting three groups for echocardiographic  evaluation – patients with an audible murmur on clinical examination, patients with resistant prolactinomas on high doses of cabergoline and patients >65 years who have a higher background risk of valvular abnormalities.

Nothing to Disclose: CC, DLP, WJI

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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