The Role of Isotretinoin Therapy for Cushing's Disease: Results of a Prospective Study

Abstract

Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushing's disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6-12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6-12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism.

Figure 1

Patients UFC levels (baseline and during isotretinoin therapy). Ten patients (7 to 16) were withdrawn from the study at month 6 (week 24) due to poor response whereas the remaining 6 patients (1 to 6) were given an additional 6 months (24 weeks); 2 of them (5 and 6) subsequently developed relapse of hypercortisolism. Overall, 4 (25%) patients (1 to 4) achieved sustained UFC normalization.