title: Cushing's Disease: Sustained remission in five cases induced by medical therapy with the dopamine agonist cabergoline.
abstract: We report five cases of Cushing's disease where the patients were given a therapeutic trial of cabergoline. Morning serum cortisol, adrenocorticotrophic hormone (ACTH), and sleeping cortisol concentrations were significantly raised. Magnetic resonance imaging (MRI) scans revealed pituitary microadenomas in 3 patients but were normal in the others. Ectopic ACTH production was excluded in the 2 patients with normal MRI scans. All were given a therapeutic trial of cabergoline (1 mg daily). Four patients responded with a prompt fall in serum cortisol levels and had a sustained clinical and biochemical remission for 378, 44, 28 and 14 days, respectively. One patient failed to respond. In conclusion, we suggest that all patients with Cushing's disease should undergo a therapeutic trial of cabergoline. Responders can then be prepared for surgery or, if needed, treated medically in the long term.
authors.affiliation: Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman;
authors.forename: Omayma
authors.initials: O
authors.lastname: Elshafie
authors.forename: Anjum
authors.initials: A
authors.lastname: Osman
authors.forename: Fatima
authors.initials: F
authors.lastname: Aamer
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Mamari
authors.forename: Njy
authors.initials: N
authors.lastname: Woodhouse
keywords: Adrenocorticotrophic hormone; Cabergoline; Case report; Cushing’s disease; Dopamine receptors; Oman