Merits and pitfalls of mifepristone in Cushing's syndrome.
OBJECTIVE
Mifepristone is the only available glucocorticoid receptor antagonist. Only few adult patients with hypercortisolism were treated to date by this drug. Our objective was to determine effectiveness and tolerability of mifepristone in Cushing's syndrome (CS).


METHODS
Retrospective study of patients treated in seven European centers.


METHODS
Twenty patients with malignant (n=15, 12 with adrenocortical carcinoma, three with ectopic ACTH secretion) or benign (n=5, four with Cushing's disease, one with bilateral adrenal hyperplasia) CS were treated with mifepristone. Mifepristone was initiated with a median starting dose of 400 mg/day (200-1000). Median treatment duration was 2 months (0.25-21) for malignant CS, and 6 months (0.5-24) for benign CS. Clinical (signs of hypercortisolism, blood pressure, signs of adrenal insufficiency), and biochemical parameters (serum potassium and glucose) were evaluated.


RESULTS
Treatment was stopped in one patient after 1 week due to severe uncontrolled hypokalemia. Improvement of clinical signs was observed in 11/15 patients with malignant CS (73%), and 4/5 patients with benign CS (80%). Psychiatric symptoms improved in 4/5 patients within the first week. Blood glucose levels improved in 4/7 patients. Signs of adrenal insufficiency were observed in 3/20 patients. Moderate to severe hypokalemia was observed in 11/20 patients and increased blood pressure levels in 3/20 patients.


CONCLUSIONS
Mifepristone is a rapidly effective treatment of hypercortisolism, but requires close monitoring of potentially severe hypokalemia, hypertension, and clinical signs of adrenal insufficiency. Mifepristone provides a valuable treatment option in patients with severe CS when surgery is unsuccessful or impossible.
Castinetti
F
F
Service d'Endocrinologie, diabète et maladies métaboliques, et Centre de reference des maladies rares d'origine hypophysaires DEFHY, Hôpital de la Timone, Marseille 13005, France. fredcast@umich.edu
Fassnacht
M
M
Johanssen
S
S
Terzolo
M
M
Bouchard
P
P
Chanson
P
P
Do Cao
C
C
Morange
I
I
Picó
A
A
Ouzounian
S
S
Young
J
J
Hahner
S
S
Brue
T
T
Allolio
B
B
Conte-Devolx
B
B
D000309:Adrenal Insufficiency / Q000139:chemically induced; D000328:Adult; D003480:Cushing Syndrome / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007008:Hypokalemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D015735:Mifepristone / Q000009:adverse effects* / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
D015735:Mifepristone