Acute administration of alprazolam, a benzodiazepine activating GABA receptors, inhibits cortisol secretion in patients with subclinical but not overt Cushing%26apos;s syndrome

作者：Giordano Roberta^*; Berardelli Rita; Karamouzis Ioannis; D' Angelo Valentina; Picu Andreea; Zichi Clizia; Fussotto Beatrice; Manzo Maria; Mengozzi Giulio; Ghigo Ezio; Arvat Emanuela

来源：Pituitary, 2013, 16(3): 363-369.

DOI：10.1007/s11102-012-0433-5

• Alprazolam
• Cortisol
• Dexamethasone test
• Subclinical Cushing%26apos
• s syndrome

The purpose of this study is to verify whether acute pre-treatment with alprazolam (ALP), a benzodiazepine that inhibits HPA secretion in normal subjects, could better characterize patients with subclinical Cushing%26apos;s syndrome (SCS) than the 1-mg dexamethasone test (DST). In 22 patients with SCS, 10 with overt Cushing%26apos;s syndrome (CS), 11 with non-functioning adrenal incidentalomas (NF) and 14 normal subjects (NS) we studied the effect of ALP (1 mg, p.o. at 2300 hours) on cortisol levels after 1-mg DST. Cortisol levels (mean +/- A SEM) after DST were lower (P = 0.012) in SCS (3.9 +/- A 0.3 mu g/dl) than in overt CS (10.4 +/- A 1.9 mu g/dl), while they were higher (P = 0.0005) than in NF (1.1 +/- A 0.1 mu g/dl) and NS (1.5 +/- A 0.1 mu g/dl). After ALP pre-treatment, cortisol levels further decreased (P = 0.004) in SCS (3.0 +/- A 0.3 mu g/dl), but neither in CS (9.3 +/- A 1.3 mu g/dl) nor in NF (1.3 +/- A 0.1 mu g/dl) and in NS (1.3 +/- A 0.1 mu g/dl). In SCS, cortisol levels after ALP + 1-mg DST persisted lower (P = 0.0005) than those in CS, but higher (P = 0.0005) than those in NF and NS. Considering individual cases, ALP pre-treatment reduced cortisol levels %26lt; 3 and %26lt; 1.8 mu g/dl in 50 and 23 % of SCS patients, respectively. ALP amplifies the cortisol inhibition exerted by 1-mg DST in patients with SCS but not in those with CS. The clinical usefulness of ALP to increase the sensitivity of 1-mg DST to identify true autonomous cortisol release in patients with adrenal incidentalomas as well as to predict different clinical outcomes remains to be clarified.

• 出版日期2013-9