Cabergoline treatment in Cushings disease: effect on hypertension, glucose intolerance and dyslipidemia.
Rosario Pivonello1, Maria Cristina De Martino1, Antongiulio Faggiano1, Monica De Leo1, Gaetano Lombardi1, Leo J Hofland2, Steven WJ Lamberts2 & Annamaria Colao1
Cabergoline has been recently demonstrated to normalize cortisol secretion in more than one third of patients with Cushings disease (CD). The aim of this study was to evaluate short-term (3-months) and long-term (12-24 months) effects of cabergoline treatment on the main systemic complications of CD, including hypertension, glucose intolerance and dyslipidemia. Twenty patients with CD unsuccessfully treated by neurosurgery entered the study. Cabergoline was admistered at the initial dose of 1 mg/week and a maximal dose of 7 mg/week. At 3-months follow-up, 15 (75%) patients were responsive whereas 5 (25%) were resistant to cabergoline treatment. Systolic and diastolic blood pressure, serum glucose and insulin levels, HOMA index, and serum cholesterol levels significantly decreased in parallel with the normalization of cortisol secretion. A significant improvement of blood pressure and a slight improvement in glucose tolerance and cholesterol levels was found both in responsive and resistant patients. Cabergoline treatment was continued in the 15 responsive patients, although treatment escape was observed in 5 patients, so that the long-term study was performed in 10 patients, who was followed-up for 12-24 months. During long-term treatment, urinary cortisol levels remained within the normal range. Serum glucose and insulin levels, HOMA index and serum cholesterol levels further decreased. At the last follow-up, the prevalence of hypertension decreased from 50% to 0%, glucose intolerance from 62.5% to 30%, and dyslipidemia from 33.3% to 0%. In conclusion, the results of the current study confirmed that cabergoline treatment is effective in controlling cortisol secretion for at least 1-2 years in more than one third of patients with CD, and demonstrated that it is able to improve hypertension, glucose intolerance and dyslipidemia in patients responsive and, partially, also in patients resistant to the treatment. Therefore, cabergoline is confirmed to be a useful treatment option in patients with CD unsuccessfully treated by neurosurgery.