Effects of Reserpine Treatment on Pituitary-Adrenocortical Axis in Patients with Cushing's Disease.

Abstract

Abstract. Effects of reserpine treatment, not associated with pituitary irradiation, on the pituitaryadrenocortical axis in a total of 37 untreated patients with Cushing's disease were evaluated. With short-term treatment (2 mg daily for 2 weeks, n=36), basal excretion of urinary 17-OHCS significantly decreased from 11.2±5.2 mg/day/m2 (body surface area) (mean ± SD) to 9.6±4.4 mg/day/m2 (P<0.01), and metyrapone-induced incremental responses of urinary 17-OHCS decreased from 58.4±41.4 mg/3 days/m2 to 45.9±29.8 mg/3 days/m2 (P<0.05). Long-term treatment (1.7±0.3 mg/day for a mean of 15.8± 19.9 weeks) induced a marked reduction in plasma cortisol, and 24-h urinary 17-OHCS and/or free cortisol in 4 of 8 patients examined. Long-term reserpine administration caused normal suppression of plasma cortisol (or 11-OHCS) in 3 of 9 patients with 1 mg, and in all of 5 patients with an 8 mg overnight dexamethasone suppression test. Plasma ACTH response to CRH was evidently decreased in one patient evaluated one month after the initiation of reserpine. The circadian rhythm of plasma cortisol was normal in one patient when the basal glucocorticoid level became normal with reserpine treatment. The present findings suggest that reserpine itself contributes in a causal fashion to the effectiveness of our regimen, reserpine and pituitary irradiation, for some Cushing's disease patients in whom it is effective.

Long Term Follow-up of Cushing's Disease Treated with Reserpine and Pituitary Irradiation Followed by Subtotal Adrenalectomy.

“…In addition, as in the patients who achieved long term remission with our regimen alone in our previous reports (Miura et al 1975;Murayama et al 1992), normal suppressibility of plasma cortisol was observed in the present group of patients, even though some of them relapsed subsequently. According to our most recent study, reserpine treatment alone, not combined with pituitary irradiation, sometimes improved suppressibility of plasma cortisol with low and high dose dexamethasone, and restored the normal diurnal rhythm of plasma cortisol, and normal response of plasma GH to 1-arginine or insulin-induced hypoglycemia tests in Cushing's disease (Minamori et al 1993). All these results suggest that reserpine plays a crucial role in improving the secretory function of various pituitary hormones in patients achieving remission with our regimen with and without an additional adrenal operation.…”

Pharmacological Therapy of Cushings Syndrome: Drugs and Indications

“…The effects of reserpine treatment, not associated with pituitary irradiation, were also examined in untreated patients with Cushing's disease [71]. Long-term treatment (mean dose 1.7 mg per day, mean duration 15.8 weeks) induced a marked reduction in plasma cortisol, and 24-hour urinary 17-hydroxycorticosteroids and/or free cortisol in 4 of 8 examined patients.…”