Syndrome de Cushing : quoi de neuf concernant les traitements

Abstract : Equine Cushing’s disease is characterised by increased secretion of par intermedia peptides as a result of loss of tonic dopaminergic inhibition. Adrenal stimulation and hyperadrenocorticism is not a typical feature. Dopaminergic agonist drugs such as pergolide are the most logical choices although there is also evidence that cyproheptadine might be efficacious via unclear mechanisms. As PPID is a heterogeneous disease, it appears that different cases require different drug doses. The effective dose can be judged on the basis of clinical response and/or by comparing pre- and port-treatment laboratory data. In approximately 75% of treated cases plasma ACTH either returns to reference range or decreases by >50% of baseline after initial dosing. It is recommended that plasma ACTH is measured 4 weeks after starting pergolide treatment and the dosage adjusted if necessary up to the maximum affordable dose or up to10 microg/kg if required. Horses failing to respond to the maximum dose might sometimes eventually respond much later after chronic therapy or, alternatively can be switched to cyproheptadine or have combination therapy with pergolide and cyproheptadine. […]