Amaç: Kabergolinin yüksek dozda uzun süreli kullanımına bağlı kalp disfonksiyonun gelişebildiği bilinmesine rağmen düşük doz kullanımı ile ilgili literatürde yeterli bir bilgi bulunmamaktadır. Bu çalışmamızda, fonksiyonel hipofizer adenom nedeniyle düşük doz uzun süreli kabergolin kullanımı ile kalp kapak disfonksiyonu arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamıza fonksiyonel hipofizer adenom nedeniyle (prolaktinoma ve akromegali) en az 1 yıl düşük doz (0,5-1 mg/hafta) kabergolin kullanan hastalar alındı. Prolaktinoma tanısı olup kabergolin alan Grup 1A (n=50), almayan sağlıklı kontrol grubu Grup 1B (n=47); akromegali tanısı olup kabergolin alan Grup 2A (n=29), almayan Grup 2B (n=22) olarak adlandırıldı. Denekler, kalp kapak yetersizliği açısından transtorasik ekokardiyografiyle değerlendirildi. Bulgular: Kabergolin kullanan Grup 1A ve Grup 2A hastalarında hafif kalp kapak yetersizliği görülme oranı daha yüksek izlenirken, orta ve ağır derecede kalp kapak yetersizliğine ise hiç rastlanılmadı. Kabergolin medyan kümülatif dozu Grup 1A'da 169 mg [çeyrekler arası aralık (ÇAA), 104-377 mg] iken, Grup 2A'da medyan 310 mg (ÇAA, 208-572 mg) olarak bulundu (p=0,009). Kapak yetersizliğini öngörebilmek için oluşturulan Cox oransal hazard regresyon analizinde univaryant ve multivaryant analizlerde kümülatif kabergolin dozu etkili faktör olarak gözlendi [sırasıyla hazard ratio: 0,99 (%95 güven aralığı, 0,995-0,999), p<0,001; hazard ratio: 0,99 (%95 güven aralığı, 0,995-0,999), p=0,001]. Sonuç: Hipofizer adenomlarda uzun süreli düşük doz kabergolin kullanımı hafif derecede kalp kapak yetersizliği ile ilişkili olabilir.
Anahtar Kelimeler: Prolaktinoma; kabergolin; kalp kapak disfonksiyonu; ekokardiyografi
Objective: Although it is known that cardiac dysfunction may develop due to long-term use of cabergoline at high doses, there is not enough information in the literature on low-dose use. In this study, we aimed to investigate the relationship between low-dose longterm use of cabergoline due to functional pituitary adenoma and heart valve dysfunction. Material and Methods: Patients using low-dose (0.5-1 mg/week) cabergoline for at least one year due to functional pituitary adenoma (prolactinoma and acromegaly) were included in our study. Group 1A (n=50) with a diagnosis of prolactinoma who received cabergoline, Group 1B (n=47) of the healthy control group who did not receive it; Group 2A (n=29) diagnosed with acromegaly and receiving cabergoline was named as Group 2B (n=22) not receiving it. Subjects were evaluated by transthoracic echocardiography for heart valve failure. Results: The incidence of mild heart valve failure was higher in Group 1A and Group 2A patients using cabergoline, while moderate and severe heart valve failure was not observed at all. The median cumulative dose of cabergoline was 169 mg [interquartile range (IQR), 104-377 mg] in Group 1A, compared to a median 310 mg (IQR, 208- 572 mg) in Group 2A (p=0.009). In the Cox proportional hazard regression analysis created to predict heart valve failure, cumulative cabergoline dose was observed as the effective factor in univariant and multivariate analyzes [hazard ratio: 0.99 (95% confidence interval, 0.995-0.999), p<0.001; hazard ratio: 0.99 (95% confidence interval, 0.995-0.999), p=0.001]. Conclusion: Long-term use of low-dose cabergoline in pituitary adenomas may be associated with mild heart valvular insufficiency.
Keywords: Prolactinoma; cabergoline; cardiac valve disfunction; echocardiography
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