Cabergoline may act as a radioprotective agent in Cushing's disease

Thakkar, Kunal; Lila, Anurag; Sarathi, Vijaya; Ramteke-Jadhav, Swati; Goroshi, Manjunath; Memon, Saba Samad; Krishnatry, Rahul; Gupta, Tejpal; Jalali, Rakesh; Goel, Atul; Shah, Abhidha; Sankhe, Shilpa; Patil, Virendra; Bandgar, Tushar; Shah, Nalini

doi:10.1111/cen.14123

Cited by 12 publications

(5 citation statements)

References 20 publications

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“…Radiotherapy is a valid therapeutic option, with median remission rates of 80% (123 patients in 7 studies), no recurrence rate and a median time to remission of 8 months [60]. However, cabergoline must not be used during radiotherapy, as it may increases recurrence rate due to a recently published study [61]. New hypopituitarism is a common problem in up to 38 [62]-40% of patients [63].…”

Section: Radiation Therapymentioning

confidence: 99%

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

et al. 2020

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Purpose Recurrence after pituitary surgery in Cushing’s disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. Methods We systematically screened the literature regarding recurrent and persistent Cushing’s disease using the MESH term Cushing’s disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. Results and conclusions Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.

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Section: Radiation Therapymentioning

confidence: 99%

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

et al. 2020

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“…Sheehan et al observed that the remission was faster in the group in which medical therapy was withdrawn around the time of GKS [9]. Thakkar et al reported that remission was not affected in patients with cabergoline treatment in peri-radiotherapy period, but recurrence was found to be increased [51]. In our study, although the number of patients was small, especially in terms of cabergoline use, there was no significant difference in the rate of-and time to remission between patients using and those not using ketoconazole and/or cabergoline before RT.…”

Section: Gks N ( %)mentioning

confidence: 99%

Efficacy and Safety of Stereotactic Radiotherapy in Cushing’s Disease: A Single Center Experience

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et al. 2020

Exp Clin Endocrinol Diabetes

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Objective To determine the efficacy and safety of stereotactic RT in patients with Cushing’s disease (CD). Methods The study included 38 patients [31 patients who received gamma knife radiosurgery (GKS) and 7 patients who received cyberknife hypofractionated RT (HFRT)] with CD. Hormonal remission was considered if the patient had suppressed cortisol levels after low dose dexamethasone, normal 24-hour urinary free cortisol (UFC), and lack or regression of clinical features. Results Biochemical control after RT was observed in 52.6% of the patients with CD and median time to hormonal remission was 15 months. Tumor size control was obtained in all of the patients. There was no significant relationship between remission rate and laboratory, radiological and pathological variables except for preoperative UFC. Remission rate was higher in patients with lower preoperative UFC. Time to remission increased in parallel to postoperative cortisol and 1mg DST level. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to hormonal remission. Conclusion In this current single center experience, postoperative cortisol and 1mg DST levels were found as the determinants of time to remission. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to biochemical control . This latter finding might suggest a radioprotective effect of cortisol lowering medication use on peri-RT period.

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“…Given the latency until post-RT remission, adjuvant medical therapy is needed to control hypercortisolism; periodic withdrawal allows cortisol secretion evaluation to assess treatment effect. 7 Although data are mixed on whether ketoconazole 246,249 or cabergoline 250 treatment at the time of SRS limits efficacy, they are often withheld temporarily at the time of RT. Hypopituitarism is the most common side effect of both conventional RT and SRS, seen in 25-50% of patients, and generally increases over time.…”

Section: Introductionmentioning

confidence: 99%