title: The Role of Isotretinoin Therapy for Cushing's Disease: Results of a Prospective Study.
abstract: Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushing's disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6-12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6-12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism.
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Lucio
authors.initials: L
authors.lastname: Vilar
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: José Luciano
authors.initials: JL
authors.lastname: Albuquerque
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Ruy
authors.initials: R
authors.lastname: Lyra
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Erik
authors.initials: E
authors.lastname: Trovão Diniz
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Frederico
authors.initials: F
authors.lastname: Rangel Filho
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Gadelha
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Thé
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: George Robson
authors.initials: GR
authors.lastname: Ibiapina
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Barbara Sales
authors.initials: BS
authors.lastname: Gomes
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Vera
authors.initials: V
authors.lastname: Santos
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Maíra
authors.initials: M
authors.lastname: Melo da Fonseca
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Karoline
authors.initials: K
authors.lastname: Frasão Viana
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Isis Gabriella
authors.initials: IG
authors.lastname: Lopes
authors.affiliation: Division of Endocrinology, Hospital das Clínicas, Pernambuco Federal University, Avenida Professor Moraes Rego, 1235, Cidade Universitária, 50670-901 Recife, PE, Brazil.
authors.forename: Douglas
authors.initials: D
authors.lastname: Araújo
authors.affiliation: Division of Endocrinology, Brasilia University Hospital, Brasilia, DF, Brazil.
authors.forename: Luciana
authors.initials: L
authors.lastname: Naves