CORTISOL SECRETORY PATTERNS IN CUSHINGS-DISEASE AND RESPONSE TO CYPROHEPTADINE TREATMENT

To investigate whether cortisol secretory patterns are associated with a response to cyproheptadine treatment in Gushing's disease, we studi ed two patients with a hyperpulsatile pattern and one patient with a h ypopulsatile pattern before and during chronic cyproheptadine therapy (24 mg daily). In the two patients with a hyperpulsatile cortisol secr etory pattern, pituitary magnetic resonance imaging with gadolinium di d not reveal a pituitary adenoma, whereas in the patient with a hypopu lsatile cortisol secretory pattern, a microadenoma was identified. Pla sma cortisol levels were measured every 30 min for 24 h. In the two pa tients with a hyperpulsatile cortisol secretory pattern, chronic treat ment with cyproheptadine resulted in sustained clinical and biochemica l improvement and normalization of the median of absolute and relative increments in cortisol spikes. In the patient with a hypopulsatile co rtisol secretory pattern, only a reduction of cortisol spikes was noti ced during treatment. These results suggest that patients with Gushing 's disease who are characterized by a hyperpulsatile cortisol secretor y pattern and in whom no pituitary lesion can be identified by magneti c resonance imaging, cyproheptadine treatment may be useful.