Hayes Annabelle G, Shirazi Masoumeh G, Thiyagarajah Anand, Torpy David J, De Sousa Sunita M C
Flinders Medical Centre, Adelaide, SA, Australia.
University of Adelaide, Adelaide, SA, Australia.
Endocr Oncol. 2022 Dec 14;3(1):e220086. doi: 10.1530/EO-22-0086. eCollection 2023 Jan 1.
Cabergoline-associated valvulopathy (CAV) is defined by the echocardiographic triad of moderate or severe regurgitation, valvular thickening and restricted valvular motion. While it is a well-described complication of dopamine agonist therapy in Parkinson's disease, only three convincing cases of CAV have previously been described in the treatment of prolactinoma, with none involving the tricuspid valve. We describe a case of CAV affecting the tricuspid valve, ultimately resulting in the patient's death. The novel finding of CAV affecting the tricuspid valve suggests a possible link between confirmed cases of CAV and the echocardiographic surveillance studies of cabergoline-treated prolactinoma patients which have mostly demonstrated subclinical tricuspid valve changes. The risk of CAV, although small, prompts a mindful prescription of dopamine agonist therapy for prolactinomas and consideration of measures to minimise cabergoline exposure. The cumulative cabergoline doses and duration of therapy associated with CAV in published cases exceed what has been evaluated in case series and surveillance studies, underscoring the importance of case reports in understanding CAV.
卡麦角林相关性瓣膜病（CAV）的定义是超声心动图显示的中度或重度反流、瓣膜增厚和瓣膜活动受限三联征。虽然这是帕金森病多巴胺激动剂治疗中一种已被充分描述的并发症，但此前在泌乳素瘤治疗中仅报道过3例令人信服的CAV病例，且均未累及三尖瓣。我们报告1例累及三尖瓣的CAV病例，最终导致患者死亡。累及三尖瓣的CAV这一新发现提示，已确诊的CAV病例与卡麦角林治疗的泌乳素瘤患者的超声心动图监测研究之间可能存在联系，这些研究大多显示有亚临床三尖瓣改变。CAV的风险虽小，但促使医生在治疗泌乳素瘤时谨慎使用多巴胺激动剂，并考虑采取措施尽量减少卡麦角林的暴露。已发表病例中与CAV相关的卡麦角林累积剂量和治疗持续时间超过了病例系列研究和监测研究中的评估值，这突出了病例报告在理解CAV方面的重要性。
