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RESPONSE TO NEUROTRANSMITTER MODULATING DRUGS IN PATIENTS WITH CUSHING'S DISEASE
Author(s) -
KOPPESCHAAR H. P. F.,
CROUGHS R. J. M.,
THIJSSEN J. H. H.,
SCHWARZ F.
Publication year - 1986
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1986.tb03621.x
Subject(s) - bromocriptine , medicine , endocrinology , cyproheptadine , valproic acid , carbamazepine , cushing's disease , gastroenterology , epilepsy , disease , prolactin , hormone , serotonin , receptor , psychiatry
SUMMARY We designed a systematic study of patients with Cushing's disease to compare the results of acute experiments with cyproheptadine, sodium valproate and bromocriptine with the results of chronic treatment with sodium valproate. In 13 patients the plasma Cortisol response to single doses of 2.5 mg bromocriptine, 6 mg cyproheptadine and 300 mg sodium valproate was assessed over 4.8 h. All patients were then treated with sodium valproate 200 mg three times a day for a period of 3 months. Subjects were classified as responders when there was a reduction in plasma Cortisol by at least 50% below the basal level in two consecutive plasma samples during one of these tests, and/or clinical remission and normalization of Cortisol production rate during sodium valproate treatment. Four patients responded significantly to at least one of the agents (group I) and 9 did not (group II). In group I three patients were bromocriptine responsive and one of these responded also to cyproheptadine; in this patient both sodium valproate and cyproheptadine were able to induce a remission during chronic treatment. In the one patient of the responder group who was bromocriptine insensitive, sodium valproate treatment also induced a remission. In two patients of the responder group sodium valproate treatment was ineffective. However, in both patients chronic treatment with bromocriptine induced a marked clinical improvement associated with a decrease of Cortisol production rate. There was no difference between the groups in sex, age, clinical presentation, duration or severity of hypercortisolism. In one patient in group I a macroadenoma with suprasellar extension was present, while a microadenoma was detected in four patients in group II. There was no difference in the sensitivity of Cortisol secretion to the suppressive effect of overnight or 5 h infusion of dexamethasone between the two groups, and PRL levels were normal in all. These data show that responsiveness of patients with Cushing's disease to neurotransmitter modulating drugs is not associated by specific clinical or biochemical characteristics. Bromocriptine tests most reliably predict the chances for successful medical treatment. However, non‐responsiveness to acute administration of neurotransmitter modulating drugs does not exclude with certainty their usefulness during chronic treatment.