Rapid Reversal of Acute Psychosis in the Cushing Syndrome with the Cortisol-Receptor Antagonist Mifepristone (RU 486) (1991)

Brief Reports15 January 1991Rapid Reversal of Acute Psychosis in the Cushing Syndrome with the Cortisol-Receptor Antagonist Mifepristone (RU 486)Aart-Jan van der Lely, MD, Karin Foeken, MD, Roos C. van der Mast, MD, Steven W. J. Lamberts, MDAart-Jan van der Lely, MD, Karin Foeken, MD, Roos C. van der Mast, MD, Steven W. J. Lamberts, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-2-143 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe progesterone-receptor antagonist, RU 486 (mifepristone), is also, at higher concentrations, an effective antagonist of glucocorticoid action in vitro and in vivo (1-3). In normal humans, RU 486 blocks glucocorticoid negative feedback at the hypothalamic-pituitary level, inducing a compensatory increase in plasma adrenocorticotropin (ACTH) and cortisol levels (4, 5). In previous studies, patients with the Cushing syndrome caused by ectopic ACTH secretion or by adrenocortical carcinomas who received therapy with RU 486 (5 to 22 mg/kg body weight per day) showed clinical improvement, and no compensatory increases in plasma ACTH or cortisol levels were noted, probably because of ongoing hypothalamic...References1. Philibert D, Deraedt R, and Teutsch G. RU 486: a potent antiglucocorticoid in vivo [Abstract]. International Congress of Pharmacology, Tokyo, Japan; 1981:1463. Google Scholar2. Proux-Ferland L, Cote J, Philibert D, and Deraedt R. Potent antiglucocorticoid activity of RU 38486 on ACTH secretion in vitro and in vivo in the rat [Abstract]. J Steroid Biochem. 1982;17:xvii. Google Scholar3. Lamberts S, Bons E, and Uitterlinden P. Studies on the glucocorticoid receptor blocking action of RU 38486 in cultured ACTH-secreting human pituitary tumor cells and normal rat pituitary cells. Acta Endocrinol (Copenh). 1985;109:64-9. CrossrefMedlineGoogle Scholar4. Bertagna X, Bertagna C, Luton J, Husson J, and Girard F. The new steroid analogue RU 486 inhibits glucocorticoid action in man. J Clin Endocrinol Metab. 1984;59:25-31. CrossrefMedlineGoogle Scholar5. Gaillard R, Poffet D, Diondel A, and Saurat J. RU 486 inhibits peripheral effects of glucocorticoids in humans. J Clin Endocrinol Metab. 1985;61:1009-14. CrossrefMedlineGoogle Scholar6. Bertagna X, Bertagna C, Laudat M, Husson J, Girard F, and Luton Z. Pituitary-adrenal response to the antiglucocorticoid action of RU 486 in Cushing's syndrome. J Clin Endocrinol Metab. 1986;63:639-42. CrossrefMedlineGoogle Scholar7. Nieman L, Chrousos G, and Nisula B. Successful treatment of Cushing's syndrome with the glucocorticoid antagonist RU 486. J Clin Endocrinol Metab. 1985;61:536-40. CrossrefMedlineGoogle Scholar8. Nieman L, Udelsman R, Loriaux D, and Chrousos C. Antiglucocorticoids: basic and clinical studies. In: D'Agata R, Chrousos GP, eds. Recent Advances in Adrenal Regulation and Function. New York: Raven Press; 1987:235-58. Google Scholar9. Haskett R. Diagnostic categorization of psychiatric disturbance in Cushing's syndrome. Am J Psychiatry. 1985;142:911-6. CrossrefMedlineGoogle Scholar10. Laue L, Callucci W, Loriaux D, Udelsman R, and Chrousos G. The antiglucocorticoid and antiprogestin steroid RU 486: its glucocorticoid agonist effect is inadequate to prevent adrenal insufficiency in primates. J Clin Endocrinol Metab. 1988;67:602-6. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Aart-Jan van der Lely, MD; Karin Foeken, MD; Roos C. van der Mast, MD; Steven W. J. Lamberts, MDFrom Erasmus University, Rotterdam, The Netherlands. For current author addresses, see end of text. 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