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

ABSTRACT

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