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Cyclical Cushing’s disease and its successful control under sodium valproate

1990; Springer Science+Business Media; Volume: 13; Issue: 11 Linguagem: Inglês

10.1007/bf03349657

1720-8386

Albert Beckers, Achille Stevenaert, G. Pirens, P. Flandroy, J. Sulon, G Hennen,

Stress Responses and Cortisol

Several subgroups of Cushing’s disease were recently described (anterior or intermediate lobe origin, hyper-or hypo-pulsatility of Cortisol, presence or absence of response after GRH or TRH, cyclical Cushing’s disease). We present here a detailed case report on a patient suffering from Cushing’s disease whose endocrine functions were extensively investigated. Treatment with bromocriptine, as well;as subsequent transsphenoidal surgery, were followed by rapid but transient reversal of symptoms. When clinical manifestations reoccurred, daily measurements of free urinary Cortisol revealed a cyclic pattern of Cortisol hyperexcretion. A study of ultradian rhythm revealed hyperpulsatility of Cortisol secretion. More interestingly, a treatment with sodium valproate, a drug known to inhibit CRH production, was followed by a rapid and longstanding normalization of clinical and biological data for 2 years. Based on these data, and on information from the literature, the present case of Cushing’s disease exhibits characteristics suggesting a possible hypothalamic origin.