ACTH AND CORTISOL RESPONSE TO BROMOCRIPTINE, AND RESULTS OF LONG-TERM THERAPY, IN CUSHING'S DISEASE

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Abstract
Plasma ACTH was lowered in 4 of 5 patients with pituitary dependent Cushing''s syndrome (1 of whom was studied only after bilateral adrenalectomy) after a single oral dose of 2.5 mg bromocriptine, but plasma cortisols were unaltered in the 3 patients in whom it was measured. Three patients were observed during treatment with bromocriptine for 16-87 wk. One improved symptomatically while maintained on a combination of metyrapone and bromocriptine, but plasma ACTH levels remained high even when the dose of bromocriptine was increased to 20 mg daily. Bromocriptine therapy was discontinued after 16 wk in the 2nd patient due to the development of mental depression. Her clinical features had not improved during this time. The 3rd patient, who also underwent a course of pituitary irradiation, became symptom free, with satisfactory plasma ACTH and cortisol levels for the 87 wk he received bromocriptine. The role of bromocriptine in the management of Cushing''s disease seems limited despite the fact that plasma ACTH may fall after a test dose of the drug.