Cortisol secretory patterns in Cushing's disease and response to cyproheptadine treatment.

Hogervorst, C. O. Van Waveren; Koppeschaar, H. P. F.; Zelissen, Pierre; Lips, C. J. M.; García, Beatriz Moreno

doi:10.1210/jcem.81.2.8636284

Cited by 5 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bromocriptine, cabergoline and the serotonin antagonist cyproheptadine have been used in attempts to inhibit ACTH secretion in CD. After the early report of the use of cyproheptadine by Krieger et al ., there have been few further reports of its successful use, and in our own study in NS, cyproheptadine alone or with bromocriptine was ineffective 78–81 …”

Section: Medical Managementmentioning

confidence: 98%

“…After the early report of the use of cyproheptadine by Krieger et al ., there have been few further reports of its successful use, and in our own study in NS, cyproheptadine alone or with bromocriptine was ineffective. [78][79][80][81] Bromocriptine has been reported to be successful in cases associated with both normal and elevated serum prolactin levels. [82][83][84][85][86][87][88][89] However, it is possible that publication bias towards reports of success may skew the overall picture and no controlled trials have been published.…”

Section: Dopamine Agonists and Serotonin Antagonistsmentioning

confidence: 99%

See 1 more Smart Citation

Endocrine clinical update: Where are we in the therapeutic management of pituitary‐dependent hypercortisolism?

Mullan

Atkinson

2007

Clinical Endocrinology

View full text Add to dashboard Cite

Section: Medical Managementmentioning

confidence: 98%

Section: Dopamine Agonists and Serotonin Antagonistsmentioning

confidence: 99%

Endocrine clinical update: Where are we in the therapeutic management of pituitary‐dependent hypercortisolism?

Mullan

Atkinson

2007

Clinical Endocrinology

View full text Add to dashboard Cite

“…More recent evidence refers to different serotoninergic agents, such as ketanserine and ritanserine (84,462,470). The potential efficacy of these compounds is based on the assumption that they have a direct serotoninergic control of the central nervous system on the hypothalamic factors that promote ACTH secretion (584), or that they may exert a direct inhibitory effect on CRH and AVP secretion from the hypothalamus (585). Studies in normal subjects have revealed that cyproheptadine treatment induces a decrease in basal ACTH values (586), whereas metergoline treatment induces a decrease in the ACTH response to metyrapone (587).…”

Section: Neuromodulatory Drugsmentioning

confidence: 99%

The Treatment of Cushing's Disease

et al. 2015

View full text Add to dashboard Cite

Cushing's disease (CD), or pituitary-dependent Cushing's syndrome, is a severe endocrine disease caused by a corticotroph pituitary tumor and associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 78% and relapse in around 13% of patients during the 10-year period after surgery, so that nearly one third of patients experience in the long-term a failure of surgery and require an additional second-line treatment. Patients with persistent or recurrent CD require additional treatments, including pituitary radiotherapy, adrenal surgery, and/or medical therapy. Pituitary radiotherapy is effective in controlling cortisol excess in a large percentage of patients, but it is associated with a considerable risk of hypopituitarism. Adrenal surgery is followed by a rapid and definitive control of cortisol excess in nearly all patients, but it induces adrenal insufficiency. Medical therapy has recently acquired a more important role compared to the past, due to the recent employment of novel compounds able to control cortisol secretion or action. Currently, medical therapy is used as a presurgical treatment, particularly for severe disease; or as postsurgical treatment, in cases of failure or incomplete surgical tumor resection; or as bridging therapy before, during, and after radiotherapy while waiting for disease control; or, in selected cases, as primary therapy, mainly when surgery is not an option. The adrenal-directed drug ketoconazole is the most commonly used drug, mainly because of its rapid action, whereas the glucocorticoid receptor antagonist, mifepristone, is highly effective in controlling clinical comorbidities, mainly glucose intolerance, thus being a useful treatment for CD when it is associated with diabetes mellitus. Pituitary-directed drugs have the advantage of acting at the site responsible for CD, the pituitary tumor. Among this group of drugs, the dopamine agonist cabergoline and the somatostatin analog pasireotide result in disease remission in a consistent subgroup of patients with CD. Recently, pasireotide has been approved for the treatment of CD when surgery has failed or when surgery is not an option, and mifepristone has been approved for the treatment of Cushing's syndrome when associated with impairment of glucose metabolism in case of the lack of a surgical indication. Recent experience suggests that the combination of different drugs may be able to control cortisol excess in a great majority of patients with CD.

show abstract

Untitled

et al. 2000

View full text Add to dashboard Cite

Central serotonergic regulation could have a role in the course of pituitary-dependent Cushing's disease. We studied the effects of ritanserin and ketanserin, two related selective 5HT2 receptor antagonists, in 11 patients with Cushing's disease. Treatment lasted from 1 month to 1 year (up to 4 years in one patient). Daily doses were 10-15 mg for ritanserin, and 40-80 mg for ketanserin. Since the two drugs share the same mechanism of action and no qualitative or quantitative differences in response to their administration were observed, the results were pooled together. Patients were assessed by clinical and hormonal evaluation. Urinary cortisol and ACTH were considered the parameters of interest. Short-term response: after 1 month, there was a significant decrease of urinary cortisol from 781 (160) to 331 (215) nmol/d (P < 0.02) while ACTH was 9.8 (1.5) pmol/L baseline and again 8.8 (2.2) pmol/L at 1 month (P = NS). For 9 patients, hormonal parameters were available after 1 week of treatment. In this case, also ACTH levels were significantly decreased (from 9.6 (1.7) to 5.2 (1.3) pmol/L; P < 0.01) together with urinary cortisol (from 781 (194) to 372 (165) nmol/d; P < 0.01). Long-term response: in 3 patients, hormonal parameters failed to respond to serotonin receptor antagonists, which were thus discontinued. An improvement was recorded in the remaining 8 patients, that was prolonged in 3, and transient in 5. In 3 of these latter patients, a marked increase of ACTH was observed before treatment discontinuation. Ketanserin was given to 2 patients with Nelson's syndrome, with only transient ACTH decrease in one, and no changes in ACTH response to CRH after 1 month treatment in both cases. An inhibitory effect of ritanserin and ketanserin on ACTH and cortisol production in Cushing's disease appeared to be limited both in terms of duration of response and number of patients with a satisfactory outcome. However, the results may provide a better understanding of serotonergic modulation in Cushing's disease and lead to therapeutic developments.

show abstract

Cortisol secretory patterns in Cushing's disease and response to cyproheptadine treatment.

Cited by 5 publications

References 24 publications

Endocrine clinical update: Where are we in the therapeutic management of pituitary‐dependent hypercortisolism?

Endocrine clinical update: Where are we in the therapeutic management of pituitary‐dependent hypercortisolism?

The Treatment of Cushing's Disease

Untitled

Contact Info

Product

Resources

About