Use of cabergoline for the management of persistent Cushing’s disease in pregnancy

Sek, Kathleen; Deepak, Doddabele Srinivasa; Lee, Kok-Onn

doi:10.1136/bcr-2016-217855

Cited by 20 publications

(13 citation statements)

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“…Its innocuous profile during gestation has been confirmed with an increasing number of uneventful pregnancies (mostly for prolactinomas) ( 60 ). Efficacy and safety of cabergoline in CD in pregnancy is also supported by a number of case reports ( 61 – 63 ).…”

Section: Medications Approved For Other Indications Than CDmentioning

confidence: 75%

Pituitary-Directed Therapies for Cushing’s Disease

2018

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Cushing’s disease (CD) is caused by a pituitary corticotroph neuroendocrine tumor inducing uncontrolled hypercortisolism. Transsphenoidal surgery is the first-line treatment in most cases. Nonetheless, some patients will not achieve cure even in expert hands, others may not be surgical candidates and a significant percentage will experience recurrence. Many patients will thus require medical therapy to achieve disease control. Pharmacologic options to treat CD have increased in recent years, with an explosion in knowledge related to pathophysiology at the molecular level. In this review, we focus on medications targeting specifically pituitary adrenocorticotropic hormone-secreting tumors. The only medication in this group approved for the treatment of CD is pasireotide, a somatostatin receptor ligand. Cabergoline and temozolomide may also be used in select cases. Previously studied and abandoned medical options are briefly discussed, and emphasis is made on upcoming medications. Mechanism of action and available data on efficacy and safety of cell cycle inhibitor roscovitine, epidermal growth factor receptor inhibitor gefitinib, retinoic acid, and silibinin, a heat shock protein 90 inhibitor are also presented.

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Section: Medications Approved For Other Indications Than CDmentioning

confidence: 75%

Pituitary-Directed Therapies for Cushing’s Disease

2018

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“…At doses of 1.5-5 mg/week a response is expected to be around 30-50% in patients with mild or moderate disease (24). Cabergoline is only advantageous for CD in pregnancy where therapeutic options are otherwise limited (27,28). However, the most experience in CS in pregnancy is with metyrapone, which is generally well tolerated, but hypertension and preeclampsia have been reported.…”

Section: Discussionmentioning

confidence: 99%

The Multifarious Cushing’s – Lessons from a Case Series

et al. 2019

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Endogenous Cushing's syndrome is rare, with an incidence of 0.7-2.4 per a million people a year. Clinical presentation of Cushing syndrome can be pleomorphic, and establishing diagnosis can be difficult. Early recognition and rapid control of hypercortisolaemia are necessary to decrease morbidity and mortality in these patients.We report a series of 6 endogenous Cushing's syndromes of different etiologies (4 Cushing's disease and 2 adrenal Cushing's syndrome) assessed in our endocrine department over a decade (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). In order to highlight the diversity of clinical forms, diagnostic tools and specific management of this condition we labelled each case suggestively: the typical Cushing's disease, the Pseudo Cushing's, the elusive Cushing's disease, the mild autonomous cortisol hypersecretion, Cushing's syndrome in pregnancy and Cushing's disease with thromboembolism. We discussed their particularities which were revelatory for the diagnosis, such as dermatologic, cardiovascular, musculoskeletal, neuropsychiatric, or reproductive signs, reviewing literature for each manifestation. We also discuss the commonalities and differences in laboratory and imagistic findings. Therapeutic approach can also differ with respect to the particular condition of each patient and the multiple choices of therapy will be reviewed.

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“…Dopamine receptor (DR) expression in ACTH-secreting PAs has been described [ 17 ]. While several case reports have demonstrated that ACTH-secreting PAs may respond to treatment with Cabergoline [ 18 , 19 , 20 , 21 , 22 , 23 ], the results in larger cohorts of patients bearing such tumors still remain controversial [ 24 , 25 ]. However, administration of dopamine agonists is worth considering as an option to treat these tumors [ 13 , 14 ], and a clinical trial on Cabergoline treatment in corticotroph PAs (Mumbai, India ( (accessed on 6 November 2021)) [ 26 ]; trial identifier: NCT00889525; Table 1 ) has been initiated.…”

Section: Emerging Targeted Treatment Strategies At the Molecular Levelmentioning

confidence: 99%

Targeting Aggressive Pituitary Adenomas at the Molecular Level—A Review

Voellger

Zhang

Benzel

et al. 2021

JCM

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Pituitary adenomas (PAs) are mostly benign endocrine tumors that can be treated by resection or medication. However, up to 10% of PAs show an aggressive behavior with invasion of adjacent tissue, rapid proliferation, or recurrence. Here, we provide an overview of target structures in aggressive PAs and summarize current clinical trials including, but not limited to, PAs. Mainly, drug targets in PAs are based on general features of tumor cells such as immune checkpoints, so that programmed cell death 1 (ligand 1) (PD-1/PD-L1) targeting may bear potential to cure aggressive PAs. In addition, epidermal growth factor receptor (EGFR), mammalian target of rapamycin (mTOR), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) and their downstream pathways are triggered in PAs, thereby modulating tumor cell proliferation, migration and/or tumor angiogenesis. Temozolomide (TMZ) can be an effective treatment of aggressive PAs. Combination of TMZ with 5-Fluorouracil (5-FU) or with radiotherapy could strengthen the therapeutic effects as compared to TMZ alone. Dopamine agonists (DAs) are the first line treatment for prolactinomas. Dopamine receptors are also expressed in other subtypes of PAs which renders Das potentially suitable to treat other subtypes of PAs. Furthermore, targeting the invasive behavior of PAs could improve therapy. In this regard, human matrix metalloproteinase (MMP) family members and estrogens receptors (ERs) are highly expressed in aggressive PAs, and numerous studies demonstrated the role of these proteins to modulate invasiveness of PAs. This leaves a number of treatment options for aggressive PAs as reviewed here.

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Use of cabergoline for the management of persistent Cushing’s disease in pregnancy

Cited by 20 publications

References 10 publications

Pituitary-Directed Therapies for Cushing’s Disease

Pituitary-Directed Therapies for Cushing’s Disease

The Multifarious Cushing’s – Lessons from a Case Series

Targeting Aggressive Pituitary Adenomas at the Molecular Level—A Review

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