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February 26, 1992

Potential Therapeutic Effects of Ritanserin in Cushing's Disease

Author Affiliations

University of Padova (Italy) School of Medicine

JAMA. 1992;267(8):1073. doi:10.1001/jama.1992.03480080043020

To the Editor.  —Several agents directed at neurotransmitter control of corticotropin secretion, such as cyproheptadine hydrochloride and bromocriptine, have been used in the treatment of Cushing's disease with conflicting results.1 Ritanserin, a new, specific, very potent and long-acting serotonin (5-HT-2) antagonist,2 is being evaluated for a variety of psychiatric disorders3 and has been shown to impair corticotropin response to insulin-induced hypoglycemia in normal volunteers.4 We investigated the potential therapeutic effects of ritanserin in three patients with pituitary-dependent Cushing's disease, from whom informed consent was obtained.

Report of Cases. 

Case 1.  —A 57-year-old woman showed recurrence of hypercortisolism and a pituitary microadenoma on magnetic resonance imaging 7 years after successful transsphenoidal surgery. She received 10 mg/d of ritanserin for 1 month. Her urinary hydrocortisone level showed only a slight and transient decrease at 1 week, with a subsequent rise to baseline values (Table).

Case 2.  —A 45-year-old