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Cyclical Cushing’s disease and its successful control under sodium valproate

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Abstract

Several subgroups of Cushing’s disease were recently described (anterior or intermediate lobe origin, hyper-or hypo-pulsatility of Cortisol, presence or absence of response after GRH or TRH, cyclical Cushing’s disease). We present here a detailed case report on a patient suffering from Cushing’s disease whose endocrine functions were extensively investigated. Treatment with bromocriptine, as well;as subsequent transsphenoidal surgery, were followed by rapid but transient reversal of symptoms. When clinical manifestations reoccurred, daily measurements of free urinary Cortisol revealed a cyclic pattern of Cortisol hyperexcretion. A study of ultradian rhythm revealed hyperpulsatility of Cortisol secretion. More interestingly, a treatment with sodium valproate, a drug known to inhibit CRH production, was followed by a rapid and longstanding normalization of clinical and biological data for 2 years. Based on these data, and on information from the literature, the present case of Cushing’s disease exhibits characteristics suggesting a possible hypothalamic origin.

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Authors and Affiliations

  1. Endocrinologie Centre Hospitalier Universitaire, Université de Liège, Sart-Tilman B23, 4000, Liège, Belgium

    A. Beckers, G. Pirens, J. Sulon & G. Hennen

  2. Neurosurgery, Université de Liège, Sart Tilman B-23, B-4000, Liège, Belgium

    A. Stevenaert

  3. Radiology, Université de Liège, Sart Tilman B-23, B-4000, Liège, Belgium

    P. Flandroy

Authors
  1. A. Beckers
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  2. A. Stevenaert
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  3. G. Pirens
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  4. P. Flandroy
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  5. J. Sulon
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  6. G. Hennen
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Beckers, A., Stevenaert, A., Pirens, G. et al. Cyclical Cushing’s disease and its successful control under sodium valproate. J Endocrinol Invest 13, 923–929 (1990). https://doi.org/10.1007/BF03349657

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  • DOI: https://doi.org/10.1007/BF03349657

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