Cyproheptadine treatment in Cushing’s disease

Abstract

Cyproheptadine, a nonselective 5-hydroxytryptamine receptor blocking agent, reduces ACTH and beta-endorphin secretion from the ACTH-producing tumors. A 35-year-old female suffering from Cushing's disease due to microadenoma of the pituitary gland has been followed since the age of 15. Subtotal adrenalectomy followed by total adrenalectomy, pituitary irradiation, and transsphenoidal hypophysectomy, combined with second radiotherapy of the pituitary, were unsuccessful in achieving remission of the disease. Remission was achieved with cyproheptadine up to a dosage of 24 mg/day. Every attempt to discontinue cyproheptadine treatment was accompanied by recurrence of the disease. This is the first case of Cushing's disease in which cyproheptadine treatment has been the only efficacious therapy for a period of 11 yr. Cyproheptadine may be an alternative long-term therapy for Cushing's disease when other methods of treatment fail.

Treatment of Cushing's disease: a mechanistic update

“…However, clinical studies showed disappointing results (Nieman 2002, Biller et al 2008. Control of CD activity with cyproheptadine has been described in case reports (Tanakol et al 1996) at doses varying from 12 to 24 mg/day. Main side effects are somnolence, hyperphagia, and weight gain.…”

Endocrine clinical update: Where are we in the therapeutic management of pituitary‐dependent hypercortisolism?

“…Bromocriptine, cabergoline and the serotonin antagonist cyproheptadine have been used in attempts to inhibit ACTH secretion in CD. After the early report of the use of cyproheptadine by Krieger et al ., there have been few further reports of its successful use, and in our own study in NS, cyproheptadine alone or with bromocriptine was ineffective 78–81 …”

Manejo de la enfermedad de Cushing persistente tras cirugía

“…Existen experiencias iniciales del uso de antagonistas serotoninérgicos, como cipro heptadina en dosis de hasta 24 mg, diarios con respuestas parciales 71 . Sin embargo, el empleo de este fármaco no se ha demostrado eficaz en la EC.…”