Various toxicities: 4 case reportsIn a case series of 6 patients with Cushing's disease (CD), four women aged 21-59 years were described, who developed vaginal bleeding, hypokalaemia, hypothyroidism or cortisol withdrawal symptoms including nausea, diarrhea and vomiting during treatment with mifepristone for CD [not all durations of treatment to reactions onset stated; routes and outcomes not stated].Case 1: The 34-year-old woman, who was diagnosed with CD 3 years prior, presented with concerns of recurrence. Her anamnesis revealed that she had undergone pituitary surgery due to ACTH-positive pituitary adenoma and developed postoperative adrenal insufficiency. The adrenal insufficiency was resolved with hydrocortisone replacement therapy for 2 years. On presentation, she underwent 1mg dexamethasone suppression testing (DST) but findings were unremarkable. She started receiving mifepristone 300 mg/day for 2 weeks, which was further titrated to 300 mg/day and 600 mg/day on alternating days. Within 8 weeks of therapy, she reported symptomatic improvement. Four months following therapy, mifepristone was withdrawn for two weeks for repeat biochemical testing and assessment of symptom recurrence. Repeat 1mg DST along with dexamethasone-suppressed corticotropinreleasing hormone stimulation test (Dex-CRH) were both consistent with CD recurrence. She reported a return of her symptoms during the mifepristone off period; subsequently, mifepristone was reinitiated and recurrence was resolved with resolution of symptoms. She continued mifepristone for 7 months, but developed vaginal bleeding due to mifepristone. The woman elected for a bilateral adrenalectomy (BLA) to treat recurrent CD. She received unspecified glucocorticoids and mineralocorticoids replacement therapy to treat the adrenal insufficiency.Case 3: The 59-year-old woman, who had various concurrent conditions, presented with hypercortisolism and was diagnosed with CD. She started receiving mifepristone 300 mg/day. After two weeks of mifepristone treatment, glimepiride was discontinued. Mifepristone was also temporarily discontinued to wallow an emergency infected left knee surgery. Mifepristone was withheld for 11 days before surgery, and resumed nine days post-surgery at a dose of 300mg every other day for one month, and further increased to 300 mg/day for two months. She again temporarily discontinued mifepristone two weeks prior to a scheduled infected right knee surgery. Mifepristone was resumed nine days postsurgery at 300mg every other day for one week and further increased to 300 mg/day. Over the course for 11 months mifepristone at 300 mg/day, all antihypertensives and antidiabetic medications except metformin were withdrawn. She reported resolution of CD symptoms. She developed hypothyroidism and hypokalaemia due to mifepristone. The woman received treatment with levothyroxine sodium [levothyroxine] for hypothyroidism and spironolactone for hypokalaemia. She was able ambulate independently following her knee surgeries. After 11 months, CD recurrence was ...
