title: The combined use of sodium valproate and metyrapone in the treatment of Cushing's syndrome.
abstract: We have investigated the combined use of metyrapone and sodium valproate in the treatment of five cases of dexamethasone-suppressible Cushing's disease and one case with dexamethasone non-suppressible disease. Metyrapone alone reduced 24 h urinary free cortisol (UFC) and plasma cortisol concentrations. Addition of sodium valproate to metyrapone produced a further reduction in these values in five of six patients with a reduction in plasma ACTH in three of five patients who had dexamethasone-suppressible disease. Plasma 11-deoxycortisol increased markedly on metyrapone. However, addition of valproate produced a further rise in 11-deoxycortisol values in four of five patients including the patient with dexamethasone non-suppressible disease. The results suggest that valproate may be a useful addition to metyrapone in the medical treatment of some patients with Cushing's syndrome and that it may have an action both at the hypothalamus and peripherally.
authors.affiliation: Department of Medicine, St George's Hospital Medical School, London, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Nussey
authors.forename: P
authors.initials: P
authors.lastname: Price
authors.forename: J S
authors.initials: JS
authors.lastname: Jenkins
authors.forename: A R
authors.initials: AR
authors.lastname: Altaher
authors.forename: B
authors.initials: B
authors.lastname: Gillham
authors.forename: M T
authors.initials: MT
authors.lastname: Jones
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D003350:Cortodoxone / Q000097:blood; D003480:Cushing Syndrome / Q000188:drug therapy* / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000627:therapeutic use*; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D011725:Pyridines; C013109:metapyrone; D014635:Valproic Acid; D000324:Adrenocorticotropic Hormone; D003350:Cortodoxone; D006854:Hydrocortisone