title: Successful treatment with sodium valproate of a patient with Cushing's disease and gross enlargement of the pituitary.
abstract: Transfrontal hypophysectomy was performed in a patient with Cushing's disease and gross enlargement of the pituitary. Despite some reduction of cortisol production active Cushing's syndrome remained due to the presence of a tumour remnant. Medical treatment with the GABA-transaminase inhibitor sodium valproate induced hypocorticism necessitating corticosteroid substitution therapy. Nine months after sodium valproate withdrawal hypercorticism was documented. Re-institution of sodium valproate treatment induced hypocorticism again. As sodium valproate is known to induce a decrease of plasma ACTH in Nelson's syndrome, it is proposed that large tumours present at the time of diagnosis and those appearing after adrenalectomy may represent the spectrum of a single disorder. A prospective trial to study the effects of sodium valproate and other neurotransmitter modulating agents on the size and endocrine function of ACTH secreting macroadenomas is urgently needed.
mesh_terms: D015065:17-Hydroxycorticosteroids / Q000652:urine; D000236:Adenoma / Q000097:blood / Q000150:complications*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D003480:Cushing Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications*; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D015065:17-Hydroxycorticosteroids; D014635:Valproic Acid; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone