Adrenocorticotropin responsiveness to acute octreotide administration is not affected by mifepristone premedication in patients with Cushing%26apos;s disease

作者：Ferrau Francesco^*; Trimarchi Francesco; Cannavo Salvatore

来源：Endocrine, 2014, 47(2): 550-556.

DOI：10.1007/s12020-013-0163-0

• Cushing%26apos
• s disease
• Cushing%26apos
• s syndrome
• Somatostatin analogs
• Octreotide
• Mifepristone

Octreotide (OCT) is ineffective in patients with Cushing%26apos;s disease (CD) due to the cortisol-induced down-regulation of somatostatin receptor subtype 2 which was shown to be reversible in vitro by using anti-glucocorticoid mifepristone. This study aimed to verify, in vivo, if mifepristone can modulate response to acute OCT administration in patients with CD. Three men and two postmenopausal women (age 52.5 +/- 2 years) with CD were enrolled in the study. OCT (100 mu g, s.c.) was administered alone on the first day (OCT-only), and it was then given after mifepristone administration (2 9 200 mg, p. os, 12 and 1 h before OCT), 3 days later (OCT-mif). ACTH and cortisol levels were measured before OCT administration and every 60 min thereafter for 6 h. Baseline ACTH and cortisol values, nadir values and percentage decrements (Delta n) were compared during both tests. Mean ACTH-Delta n did not differ significantly during the two tests. Both tests induced a %26lt;30 % decrease in plasma ACTH in three patients (# 1, 2 and 3) and a %26gt;50 % decrease in the other two cases (# 4 and 5). Cortisol decreased in patients # 4 and 5, during both tests. ACTH-Delta n did not correlate with morning cortisol nor with urinary free cortisol values. Patients # 4 and 5 with the highest ACTH-Delta n had the lowest cortisol values after 1 mg of dexamethasone. Brief mifepristone pre-treatment does not modify ACTH and cortisol response to acute OCT administration in CD. However, OCT seems to be more effective in patients with partially preserved cortisol inhibitory feedback.

• 出版日期2014-11