Cabergoline may act as a radioprotective agent in Cushing's disease

Clin Endocrinol (Oxf). 2020 Jan;92(1):55-62. doi: 10.1111/cen.14123. Epub 2019 Nov 22.


Context: Conventional fractionated radiotherapy (CRT) achieves control of pathological hypercortisolism in 75%-80% of patients with persistent or recurrent Cushing's disease (CD), over a mean period of 18-24 months. Medical therapy is recommended as bridge therapy while awaiting RT effect.

Objective: To determine long-term outcome of CRT and its predictors in CD patients.

Design, setting and patients: This is a retrospective case record analysis of 42 patients with CD who received CRT as a treatment modality and had at least 12 months post-RT follow-up. The dose delivered was 45 Gy in 25 fractions over 5 weeks. Demographic details, hormonal evaluation and radiological data were extracted from case records. Dexamethasone suppressed cortisol at cut-off of 1.8 µg/dL was used to define remission or recurrence. Possible predictors for remission and recurrence were analysed.

Results: The mean age at the time of CRT administration was 23.7 ± 10.7 (range: 12-48) years. A total of 29 (69%) patients achieved remission 26.5 ± 28.5 (median: 18, range: 3-120) months after RT, while 13 (31%) patients had persistent disease at last follow-up. There were no significant predictors of disease remission after CRT. Six (20.7%) patients had recurrence after a documented initial remission. Recurrence occurred 66.6 ± 25.9 (median: 74; range: 18 to 90) months after documented remission. Recurrence of the disease was exclusively seen in patients who received peri-RT cabergoline. Peri-CRT use of cabergoline was significantly associated with increased recurrence rates (P = .016).

Conclusion: Use of cabergoline in the peri-CRT period did not affect initial remission after CRT but was associated with increased recurrence after initial remission in CD.

Keywords: cabergoline; conventional/conformal fractionated radiotherapy; ketoconazole; overnight dexamethasone suppression test; recurrence; remission.

MeSH terms

  • Adolescent
  • Adult
  • Cabergoline / pharmacology*
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Pituitary ACTH Hypersecretion / drug therapy*
  • Pituitary ACTH Hypersecretion / radiotherapy*
  • Radiation-Protective Agents / pharmacology*
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Young Adult


  • Radiation-Protective Agents
  • Cabergoline