Endocrine Abstracts

JOINT2140

Background: Cushing’s disease is the most common etiological agent of endogenous hypercorticism. Furthermore, 90% of corticotropic adenomas are microadenomas. While surgery is typically the go-to treatment, there are situations where medication can play a key role in managing the condition.

Case report: We present the case of a 17-year-old patient referred for evaluation of hypercortisolism. The clinical examination revealed overt signs of Cushing’s syndrome, with a predominance of catabolic manifestations: extensive, horizontal, purple stretch marks on the abdomen, axillae, and proximal limbs, as well as muscle atrophy in the girdle regions. The 24-hour urinary free cortisol (UFC) level was 7 times the upper limit of normal. A 2-day low-dose dexamethasone suppression test and an elevated ACTH level of 11.32 pmol/l(> 4.4 pmol/l)confirmed the diagnosis of ACTH-dependent Cushing’s syndrome. A high-dose suppression test further supported the diagnosis of Cushing’s disease. A pituitary MRI identified a 1.8 mm microadenoma. Since ketoconazole was not available, we started him on Cabergoline, 0.5 mg once a week, and referred him to neurosurgery for further evaluation. After 18 months, the patient had not undergone surgical intervention. Remarkably, clinical follow-up demonstrated significant regression of hypercortisolism symptoms, with normalization of 24-hour UFC levels. Repeat hypothalamic-pituitary MRI showed no change in the size of the microadenoma.

Conclusion: Depending on the series, the efficacy of cabergoline ranges from 25 to 40%. In certain cases of Cushing’s disease, particularly when accompanied by a pituitary picoadenoma, it may still be a useful treatment option.