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Bromocriptine-Responsive Cushing’s Disease Associated With Anterior Pituitary Corticotroph Hyperplasia or Normal Pituitary Gland

Departments of Endocrinology and Neurosurgery, University Hospital Utrecht The Netherlands
University Department of Pathology Royal Infirmary, Glasgow, Great Britain

Address all correspondence and requests for reprints to: Ronald J. M. Croughs, M.D., University Hospital Utrecht, Catharijnesingel 101, 3511 GV Utrecht, The Netherlands.

Cushing’s disease may originate from either the anterior pituitary lobe or the neurointermediate lobe, a major characteristic of the latter group being bromocriptine responsiveness. This study of two patients with Cushing’s disease demonstrates that bromocriptine responsiveness also may be associated with anterior pituitary corticotroph hyperplasia or a normal pituitary gland. The two patients were a 14-yr-old boy (patient 1) and a 29-yr-old woman (patient 2); their cortisol production rates were 121 and 234 µmol/24 h (normal values, <80 µmol/24 h), respectively. A single oral dose of 2.5 mg bromocriptine resulted in a gradual decrease in plasma cortisol from 680 to 130 nmol/L after 6 h in patient 1 and from 640 to 170 nmol/L after 4 h in patient 2. Both patients then received medical treatment for a period of 2 yr. Whereas sodium valproate was ineffective, bromocriptine (5 mg/day) abruptly decreased the cortisol production rate to 60 µmol/24 h in patient 1 and to 138 µmol/24 h in patient 2, and both patients had a partial clinical remission. Despite an increase in bromocriptine dosage to 30 mg daily and 24 mg/day cyproheptadine, the clinical and biochemical remission was not sustained in patient 1, and no further improvement occurred in patient 2. Total hypophysectomy then was performed in both patients. Sections of the pituitary from patient 1 showed diffuse anterior pituitary corticotroph hyperplasia, with early nodule formation in some areas. The sections from patient 2 showed normal numbers and distribution of corticotrophs. We conclude that the heterogeneous nature of Cushing’s disease cannot be explained on the basis simply of anterior vs. intermediate lobe origin of the disease.

Received June 7, 1988.

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