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.
—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).
Sonino N, Boscaro M, Fallo F, Fava GA. Potential Therapeutic Effects of Ritanserin in Cushing's Disease. JAMA. 1992;267(8):1073. doi:10.1001/jama.1992.03480080043020