CENTRAL NERVOUS-SYSTEM AND CUSHING DISEASE

The authors' initial report concerned three patients who underwent clinical remission within 1 to 3 months of achieving a dose of 24 mg of cyproheptadine daily. Such remission was accompanied by complete reversal of the clinical manifestations of hypercortisolism and normalization of urinary cortisol secretion. In one of these patients after 1 year of therapy, there was a normal response to the 2 mg dexamethasone suppression test and a normal cortisol and growth hormone response to insulin-induced hypoglycemia, both of which had previously been impaired. In addition, there was a return to a normal amount of sleep stages 3 and 4 and suggestion of a return of normal corticosteroid periodicity. In further studies by their laboratory and other investigators, it appears that approximately 60 per cent of patients with Cushing's disease respond to such therapy, although in some instances it is necessary to employ 32 mg of cyproheptadine daily, and remission may take as long as 4 to 5 months to accomplish. Continuous medication is necessary, since relapses occur on discontinuance. The authors and others have also seen marked suppression of the elevated plasma ACTH levels seen in patients with Nelson's syndrome when such patients are treated with cyproheptadine.