Cabergoline in severe ectopic or occult Cushing’s syndrome

in European Journal of Endocrinology
Correspondence should be addressed to G Raverot; Email: gerald.raverot@chu-lyon.fr
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Context

Cabergoline has been shown to have some effect in the treatment of moderate Cushing’s disease, but its effectiveness in Cushing’s syndrome of ectopic or occult origin remains to be investigated.

Case series

In this case series, cabergoline was used in combination with steroidogenesis inhibitors in nine patients with severe Cushing’s syndrome of ectopic or occult origin. Cabergoline’s effectiveness enabled rapid withdrawal of the steroidogenesis inhibitors and long-term control of the hypercortisolism in three of the cases.

Review of the literature

In the literature, we found only 11 cases of ectopic or occult Cushing’s syndrome treated with dopamine receptor agonists, alone or in combination. Yet of these 11 cases, 10 responded.

Conclusions

Although limited, the existing experience highlights the potential value of cabergoline in the treatment of ectopic or occult Cushing’s syndrome.

 

     European Society of Endocrinology

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Figures

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    Levels of urinary-free cortisol (UFC) and morning plasma adrenocorticotropic hormone (ACTH) during treatment for Cushing’s syndrome. Data are shown for case 1 (A), case 2 (B) and case 3 (C). The UFC is expressed in times the upper limit of the normal range (ULN), while the plasma ACTH is expressed in ng/L (conversion factor: ng/L × 0.22 = pmol/L). Every dot represents an individual measurement.

  • View in gallery

    Radiological and immunohistochemical images for case 1. The left pulmonary mass is indicated by a red arrow, as seen on the CT scan (A). Moderate uptake of tracer by the pulmonary mass is shown on the 18F-FDG PET/CT image (B), whereas the 68Ga-DOTATOC PET/CT image shows no uptake of the radiolabeled somatostatin analog by the pulmonary mass (C). Cytoplasmic immunoexpression of ACTH is observed in 15% of neoplastic cells (original magnification, ×200) (D).

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