Advertisement

Journal of Endocrinological Investigation

, Volume 27, Issue 11, pp 1055–1059 | Cite as

Effect of cabergoline treatment on Cushing’s disease caused by aberrant adrenocorticotropin-secreting macroadenoma

  • T. Miyoshi
  • F. Otsuka
  • M. Takeda
  • K. Inagaki
  • J. Suzuki
  • T. Ogura
  • I. Date
  • K. Hashimoto
  • H. Makino
Case Report

Abstract

The present case involves a 47-yr-old woman with Cushing’s disease due to pituitary macroadenoma. The patient had suffered from hypertension and obesity for two yr. Her serum cortisol levels were moderately elevated throughout the observation period, and dexamethasone failed to suppress the cortisol secretion. Plasma ACTH levels were markedly high (>100 pg/ml) and did not respond to CRH provocation. Gel filtration analysis of the patient’s plasma detected the existence of big ACTH molecules, which eluted with a peak of authentic 1–39 ACTH. Cranial magnetic resonance imaging (MRI) revealed a 3 cm pituitary tumor occupying the sellar region and right cavernous sinus with diffuse enhancement by gadolinium. The pituitary mass was removed by transsphenoidal surgery, and was pathologically identified as compatible to ACTH-producing pituitary adenoma by immunohistochemistry. RT-PCR analysis of total cellular RNA extracted from the resected adenoma revealed a relatively high expression level of dopamine D2 receptor (D2R) mRNA. Therefore, a long-acting D2R agonist, cabergoline (0.25 to 0.5 mg/week), was administered for the remnant adenoma, which gradually reduced ACTH levels in 90 days. In addition, cranial MRI exhibited shrinkage of the remnant pituitary mass after a 6-month treatment with cabergoline. This case demonstrates the efficacy of cabergoline to treat Cushing’s disease caused by pituitary macroadenoma secreting aberrant ACTH molecules.

Key-words

ACTH, Cushing’s disease pituitary adenoma cabergoline dopamine D2 receptor gel filtration analysis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bevan JS, Webster J, Burke CW, Scanlon MF. Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 1992, 13: 220–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Selvais P, Donckier J, Buysschaert M, Maiter D. Cushing’s disease: a comparison of pituitary corticotroph micro — adenomas and macroadenomas. Eur J Endocrinol 1998, 138: 153–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Katznelson L, Bogan JS, Trob JR, et al. Biochemical assessment of Cushing’s disease in patients with corticotroph macroadenomas. J Clin Endocrinol Metab 1998, 83: 1619–23.PubMedGoogle Scholar
  4. 4.
    Mampalam TJ, Tyrrell JB, Wilson CB. Transsphenoidal microsurgery for Cushing disease. A report of 216 cases. Ann Intern Med 1988, 109: 487–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Shimon I, Melmed S. Management of pituitary tumors. Ann Intern Med 1998, 129: 472–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Hashimoto K, Kaneda T, Nagano I, Asaba K, Takeda K, Takao T. Pituitary adenoma showing intermittent secretion of high molecular weight adrenocorticotropin without evidenice of Cushing’s disease. Horm Res 1999, 52: 39–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Takeda M, Otsuka F, Suzuki J, et al. Involvement of activin/BMP system in development of human pituitary gonadotropinomas and nonfunctioning adenomas. Biochem Biophys Res Commun 2003, 306: 812–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med 1994, 331: 904–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Verhelst J, Abs R, Maiter D, et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 1999, 84: 2518–22.PubMedCrossRefGoogle Scholar
  10. 10.
    Abs R, Verhelst J, Maiter D, et al. Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab 1998, 83: 374–8.PubMedCrossRefGoogle Scholar
  11. 11.
    T’Sjoen G, Defeyter I, Van De Saffele J, Rubens R, Vandeweghe M. Macroprolactinoma associated with Cushing’s disease, successfully treated with cabergoline. J Endocrinol Invest 2002, 25: 172–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Pivonello R, Faggiano A, Di Salle F, Filippella M, Lombardi G, Colao A. Complete remission of Nelson’s syndrome after 1-year treatment with cabergoline. J Endocrinol Invest 1999, 22: 860–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Petrossians P, Ronci N, Valdes Socin H, et al. ACTH silent adenoma shrinking under cabergoline. Eur J Endocrinol 2001, 144: 51–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Ben-Jonathan N, Hnasko R. Dopamine as a prolactin (PRL) inhibitor. Endocr Rev 2001, 22: 724–63.PubMedCrossRefGoogle Scholar
  15. 15.
    Renner U, Arzberger T, Pagotto U, et al. Heterogeneous dopamine D2 receptor subtype messenger ribonucleic acid expression in clinically nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 1998, 83: 1368–75.PubMedGoogle Scholar
  16. 16.
    Murata Y, Ando H, Nagasaka T, et al. Successful pregnancy after bromocriptine therapy in an anovulatory woman complicated with ovarian hyperstimulation caused by follicle-stimulating hormone-producing plurihormonal pituitary microadenoma. J Clin Endocrinol Metab 2003, 88: 1988–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Saiardi A, Borrelli E. Absence of dopaminergic control on melanotrophs leads to Cushing’s-like syndrome in mice. Mol Endocrinol 1998, 12: 1133–9.PubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2004

Authors and Affiliations

  • T. Miyoshi
    • 1
  • F. Otsuka
    • 1
  • M. Takeda
    • 1
  • K. Inagaki
    • 1
  • J. Suzuki
    • 1
  • T. Ogura
    • 1
  • I. Date
    • 2
  • K. Hashimoto
    • 3
  • H. Makino
    • 1
  1. 1.Department of Medicine and Clinical ScienceOkayama University Graduate School of Medicine and DentistryOkayamaJapan
  2. 2.Department of NeurosurgeryOkayama University Graduate School of Medicine and DentistryOkayamaJapan
  3. 3.Department of Endocrinology, Metabolism and Nephrology, Kochi Medical SchoolKochi UniversityKochiJapan

Personalised recommendations