MEDICAL TREATMENT IN CUSHING'S DISEASE - EXPERIENCE OF A TERTIARY CARE CENTRE
C. Cidade-Rodrigues*a (Dr), A. Maiab (Dr), I. Ribeirob (Dr), C. Amaralb (Dr)
a Centro Hospitalar do Tamega e Sousa, Penafiel, PORTUGAL ; b Centro Hospitalar Universitario do Porto, Porto, PORTUGAL
Introduction:Cushing’s disease(CD)consists of endogenous excessive glucocorticoid secretion,due to an ACTH-producing pituitary tumour.Medical therapy is necessary when surgery is delayed,contraindicated or unsuccessful.We aim to describe CD patients undergoing medical treatment in a tertiary hospital in Portugal.Methods:Retrospective study of adult CD patients followed betweenOctober/2016-December/2021,in the multidisciplinary pituitary consult at a tertiary hospital.Patients’data was reviewed trough medical records.Statistical analysis was made using Microsoft Excel®(version2205).Results:From a total of 48 patients with CD,14(1 male)were medically treated:five with ketoconazole and cabergoline,two with ketoconazole alone,one with ketoconazole and metyrapone,five with cabergoline and one with metyrapone and cabergoline.Among patients treated with ketoconazole:mean treatment’s duration and daily-dose were49±44months and450±141mg,respectively.Three patients started treatment before surgery,three for persistent disease and two for tumour relapse.Three patients presented side-effects:asthenia,orthostatic hypotension and liver enzymes elevation.Mean urinary free cortisol(UFC)and cortisol after1mg-dexametasone suppression test(1mg-DST)at diagnosis were380.00±392.41µg/24h and16.88±8.91µg/dl,respectively.At the end of follow-up, mean UFC and cortisol after1mg-DST values were 71.40±77.02µg/24h and12.98±6.96µg/dl,respectively.The patient treated with ketoconazole and metyrapone was previously treated with surgery,radiotherapy and ketoconazole;metyrapone was an add-on medical therapy,due to disease progression during treatment with ketoconazole alone.Among patients treated with cabergoline alone,mean treatment’s duration and weekly-dose were 22±19 months and1.20±0.27mg,respectively.No side-effects reported.At diagnosis,mean UFC and cortisol after DST values were544.67±950.18µg/24h and9.19±5.38µg/dl,respectively.End of follow-up mean values for UFC and cortisol after1mg-DST were76.62±40.45µg/24h and6.98±5.00µg/dl,respectively.The patient treated with metyrapone and cabergoline was previously treated with surgery,radiotherapy and ketoconazole.Treatment’s duration:12 months.Daily-dose:1000mg;No side-effects reported.Initial and final UFC were169.6µg/24h and77.00µg/24h,respectively.All showed symptomatic relief and comorbidities’ improvement(particularly hypertension,dyslipidemia and obesity).Conclusions:Our patients with CD treated with ketoconazole,metyrapone and/or cabergoline,all show a decrease in hypercortisolism’s degree,with few side-effects,underlining that these drugs are a safe choice for CD patients who have relapsing/residual disease.
The author has declared no conflict of interest.