Cushing's disease. Sustained remission in five cases induced by medical therapy with the dopamine agonist cabergoline

We report five cases of Cushing's disease where the patients were given a therapeutic trial of cabergoline. Morning serum cortisol, adrenocorticotrophic hormone [ACTH], and sleeping cortisol concentrations were significantly raised. Magnetic resonance imaging [MRI] scans revealed pituitary microadenomas in 3 patients but were normal in the others. Ectopic ACTH production was excluded in the 2 patients with normal MRI scans. All were given a therapeutic trial of cabergoline [1 mg daily]. Four patients responded with a prompt fall in serum cortisol levels and had a sustained clinical and biochemical remission for 378, 44, 28 and 14 days, respectively. One patient failed to respond. In conclusion, we suggest that all patients with Cushing's disease should undergo a therapeutic trial of cabergoline. Responders can then be prepared for surgery or, if needed, treated medically in the long term

Thyroid cancer in Saudi Arabia

We studied the 228 patients with thyroid cancer who were referred to our hospital for the first time during a period of 2 1/2 years.There were 180 females and 48 males giving a sex ratio of 3.8:1. The median age of males at diagnosis of 58 years was significantly higher than that of females of 38 years [p = 0.00009]; 192 [84%] had papillary, 12 [5%] follicular, 13 [6%] anaplastic and 11 [5%] had medullary thyroid cancer. The median tumour size was 15cm for papillary, 25 cm for follicular, 36 cm for anaplastic and 11 cm for medullary cancer. Males had significantly bigger tumours than females [p = 0.001]. Capsular, vascular or local invasion were found in 79%, neck lymph node metastases in 68% and distant metastases in 13% of the total group of thyroid carcinomas. In conclusion, in contrast to previous reports from Europe and North America this study shows that the severity of the disease in Saudi Arabia at diagnosis is more pronounced and the age distribution in males and females is different