Document Detail


Potential role for retinoic acid in patients with Cushing's disease.
MedLine Citation:
PMID:  22851491     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Cushing's disease, i.e. cortisol excess due to an ACTH-secreting pituitary adenoma, is a rare disorder with considerable morbidity and mortality but no satisfactory medical treatment as yet. Experimental data have recently shown that retinoic acid restrains ACTH secretion by tumoral corticotropes.
OBJECTIVE: Our objective was to evaluate the efficacy and safety profile of retinoic acid treatment in patients with Cushing's disease.
DESIGN: This is a prospective, multicenter study. Seven patients with Cushing's disease (three men, four postmenopausal women) were started on 10 mg retinoic acid daily and dosage increased up to 80 mg daily for 6-12 months. ACTH, urinary free cortisol (UFC), and serum cortisol as well as clinical features of hypercortisolism and possible side effects of retinoic acid were evaluated at baseline, during retinoic acid administration, and after drug withdrawal.
RESULTS: A marked decrease in UFC levels was observed in five patients; mean UFC levels on retinoic acid were 22-73% of baseline values and normalization in UFC was achieved in three patients. Plasma ACTH decreased in the first month of treatment and then returned to pretreatment levels in responsive patients whereas no clear-cut pattern could be detected for serum cortisol. Blood pressure, glycemia, and signs of hypercortisolism, e.g. body weight and facial plethora, were ameliorated to a variable extent on treatment. Patients reported only mild adverse effects, e.g. xerophthalmia and arthralgias.
CONCLUSIONS: Long-term treatment with retinoic acid proved beneficial and well tolerated in five of seven patients with Cushing's disease. This represents a novel, promising approach to medical treatment in Cushing's disease.
Authors:
Francesca Pecori Giraldi; Alberto Giacinto Ambrogio; Massimiliano Andrioli; Francesca Sanguin; Ioannis Karamouzis; Iannis Karamouzis; Salvatore Maria Corsello; Carla Scaroni; Emanuela Arvat; Alfredo Pontecorvi; Alfredo Pontercorvi; Francesco Cavagnini
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2012-07-31
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  97     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-08     Completed Date:  2012-12-18     Revised Date:  2013-05-13    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3577-83     Citation Subset:  AIM; IM    
Affiliation:
Department of Clinical Sciences and Community Health, University of Milan, Istituto Auxologico Italiano, Piazzale Brescia 40, 20149 Milan, Italy. fpg@auxologico.it
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MeSH Terms
Descriptor/Qualifier:
ACTH-Secreting Pituitary Adenoma / drug therapy*
Adenoma / drug therapy*
Adolescent
Adrenocorticotropic Hormone / blood
Adult
Antineoplastic Agents / administration & dosage*,  adverse effects
Female
Humans
Hydrocortisone / blood,  urine
Male
Middle Aged
Pituitary ACTH Hypersecretion / drug therapy*
Prospective Studies
Treatment Outcome
Tretinoin / administration & dosage*,  adverse effects
Young Adult
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 302-79-4/Tretinoin; 50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone
Comments/Corrections
Erratum In:
J Clin Endocrinol Metab. 2013 Mar;98(3):1294
Note: Pontercorvi, Alfredo [corrected to Pontecorvi, Alfredo]
J Clin Endocrinol Metab. 2013 Jan;98(1):420
Note: Karamouzis, Iannis [corrected to Karamouzis, Ioannis]

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