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Cabergoline for Cushing's disease: a large retrospective multicenter study.

A Ferriere1, C Cortet2, P Chanson3

  • 1CHU BordeauxHôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie et Nutrition, Pessac, France or INSERM U862, Neurocentre Magendie, Université Bordeaux, Bordeaux Cedex, France.

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Cabergoline effectively manages Cushing's disease (CD) in about 20-25% of patients, offering long-term hypercortisolism control. Response to this treatment for CD is not predictable by baseline urinary free cortisol or prolactin levels.

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Area of Science:

  • Endocrinology
  • Pharmacology

Background:

  • Cushing's disease (CD) is a rare endocrine disorder caused by excess cortisol production.
  • The efficacy of cabergoline, a dopamine agonist, in treating CD remains debated.

Purpose of the Study:

  • To evaluate the efficacy and tolerability of cabergoline in a large cohort of patients with Cushing's disease.
  • To identify predictors of response to cabergoline therapy in CD.

Main Methods:

  • A retrospective multicenter study involving 62 patients with CD across 13 university hospitals.
  • Data collected included symptom scores, biological markers of hypercortisolism (urinary free cortisol - UFC, midnight cortisol, plasma ACTH), and adverse effects.
  • Patients received either cabergoline monotherapy or add-on therapy to existing treatments.

Main Results:

  • 40% of patients on monotherapy achieved normal UFC within 12 months (complete responders).
  • Complete responders showed significant reductions in hypercortisolism markers and clinical improvement, often at lower cabergoline doses.
  • Sustained hypercortisolism control was achieved in 23% of patients long-term; 56% of patients receiving cabergoline as add-on therapy also showed control.

Conclusions:

  • Approximately 20-25% of Cushing's disease patients are good responders to cabergoline, achieving long-term hypercortisolism control.
  • Cabergoline demonstrated acceptable tolerability, but treatment escape or intolerance led to discontinuation in 28% of responders.
  • No specific baseline parameters, such as UFC or prolactin levels, could predict response to cabergoline therapy.