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Cyclic Cushing's disease in long-term remission with a daily low dose of bromocriptine
M Adachi1, R Takayanagi, T Yanase
1Third Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka.
Insights
Bromocriptine effectively treated cyclic Cushing's disease in one patient for over a year at a low dose. This challenges previous findings suggesting only transient remission with higher doses for this rare disorder.
Area of Science:
- Endocrinology
- Neuroendocrinology
Background:
- Cyclic Cushing's disease is a rare disorder characterized by fluctuating hypercortisolemia.
- Previous treatments with bromocriptine for this condition have shown limited or transient efficacy, often requiring high doses.
Observation:
- A 56-year-old male patient with cyclic Cushing's disease achieved sustained remission for over a year.
- Remission was maintained with a low daily dose of bromocriptine (2.5-3.75 mg/day).
- The patient's hypercortisolemic state was unresponsive to dexamethasone suppression and corticotropin-releasing factor stimulation.
Findings:
- Low-dose bromocriptine demonstrated prolonged effectiveness in managing cyclic Cushing's disease in this case.
- The patient's condition did not respond to standard diagnostic tests for pituitary-dependent Cushing's disease, including dexamethasone and CRF challenges.
- Surgical intervention (antohypophysectomy) was ineffective despite the presence of ACTH-positive microadenomas.
Implications:
- This case suggests that bromocriptine may be an effective long-term treatment option for select patients with cyclic Cushing's disease.
- Further research is warranted to explore the efficacy of low-dose bromocriptine in a broader patient population with this rare endocrine disorder.
- The findings challenge the notion that only high-dose bromocriptine can induce remission in cyclic Cushing's disease.
Abstract:
A 56-year-old male patient with cyclic Cushing's disease remained in a state of remission for more than one year with a relatively low dose of bromocriptine (2.5-3.75 mg/day). It has been reported that bromocriptine treatment for cyclic Cushing's disease induces only a transient remission; in the most effective cases, a relatively high dose (40 mg/day) was necessary. In the hypercortisolemic state, plasma adrenocorticotropic hormone (ACTH) and serum cortisol were not suppressed by dexamethasone and did not respond to corticotropin-releasing factor (CRF). An antehypophysectomy was not effective, even though the resected tissue contained ACTH-positive microadenomas. The present observations thus indicate the effectiveness of bromocriptine for some patients with this rare disorder.