Ergot derivative dopamine agonists, e.g. pergolide, bromocriptine, dihydroergocriptine used in treatment of Parkinson’s
disease can cause pleural, pericardial, retroperitoneal and valvular fibrotic changes. Case No 1:
A 56-year-old woman with PD was treated with pergolide 3mg/24h since July 2002. In June 2003, edema of lower
extremities was first noticed and echocardiography found a minor mitral regurgitation without any morphological
changes of the valve. In January 2004, left- sided cardiac failure rapidly developed and echocardiography revealed
multivalvular insufficiency with predominating severe mitral regurgitation. Mitral valve replacement was performed
and pergolide was changed to ropinirole. Until now, neither cardiac functions nor motor status are sufficiently compensated.
Case No 2: A 66-year-old-man with PD since 1996 was treated with pergolide 3mg/day since 1999. In the
beginning of 2004, leg edema appeared. On examination, bilateral hydronephrosis with ureteric strictures and incipient
renal insufficiency was found. Bilateral ureteroplasty was performed and the histology showed periureteric fibrosis.
Treatment with steroids was initiated and pergolide was changed to pramipexole. Despite the treatment, the fibrosis
progressed, requiring ureteral stenting. Based on the literature review and on our own experience, we propose
following guidelines to minimize the risk of complications: A. Not to use EAD as the first-line dopamine agonists.
B. Regularly follow all patients treated with EAD, especially monitor the majorsymptoms: dyspnea, cough, fatigue,
leg edema (also asymmetric), symptoms of urinary outflow obstruction, cardiac insufficiency, chest pain, heart murmur.
An elevated ESR, C-reactive protein or anemia support the diagnosis. C. All symptomatic patients should undergo
workup for serosal fibrosis (according to type of complication): chest X-ray or CT scan, spirometry, renal functions,
renal ultrasound, CT of retroperitoneum. D. Before the introduction of EAD therapy, examine the renal functions,
perform chest X-ray and echocardiography. Screening echocardiography should be performed in 3–6 months and subsequently
in every 6–12 months.
Parkinson’s disease, fibrosis, ergot derivatives, pergolide.