Sunday, January 23, 2011

Efficacy of Cabergoline in Uncured (Persistent or Recurrent) Cushing Disease After Pituitary Surgical Treatment with or without Radiotherapy

JournalEndocrine Practice
PublisherAmerican Association of Clinical Endocrinologists
ISSN1530-891X (Print) 1934-2403 (Online)
IssueVolume 16, Number 6 / November-December 2010
Online DateMonday, May 24, 2010

Anurag R. Lila, MD1, Raju A. Gopal, MD, DM1, Shrikrishna V. Acharya, MD, DM1, Joe George, MD, DM1, Vijaya Sarathi, MD, DM1, Tushar Bandgar, MD, DM1, Padma S. Menon, MD1, Nalini S. Shah, MD, DM1

1Department of Endocrinology, Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, India


Objective: To evaluate the efficacy of cabergoline therapy in patients with Cushing disease who remained uncured (had persistent or recurrent disease) after a pituitary surgical procedure with or without radiotherapy.

Methods: We undertook a prospective, open-label, single-arm study, with short-term (5 months) and longterm (1 year) evaluations. In 20 patients with uncured Cushing disease, treatment was initiated with cabergoline at a dosage of 1 mg/wk, with a monthly increment of 1 mg, until midnight serum cortisol (MNSC) or low-dose dexamethasone suppression serum cortisol (LDSC) (or both) normalized or a maximal dosage of 5 mg/wk was reached.

Results: Overall, 5 of 18 patients (28%) responded in terms of LDSC or MNSC (or both) at a mean dosage of 3.6 mg/wk (range, 2 to 5). When the response was defined with use of either LDSC or MNSC level as an isolated criterion, it was achieved in 4 of 16 patients (25%) and 3 of 18 patients (17%), respectively. Four patients were treated for 1 year, and the response was persistent in 2 and 3 patients on the basis of MNSC and LDSC levels, respectively. Lower baseline serum cortisol (basal, MNSC, and LDSC) values were predictive of a therapeutic response.

Conclusion: Cabergoline was an effective therapy in 28%, 25%, and 17% of patients with uncured Cushing disease in terms of LDSC or MNSC (or both), LDSC alone, and MNSC alone, respectively. Further studies are needed to address the persistence of the drug response and the effects on the dynamics of the hypothalamic-pituitary-adrenal axis.

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