Endocrinology, University of Liège, Liège, Belgium.
Neuroendocrinology. 2010;92 Suppl 1:116-9. doi: 10.1159/000317716. Epub 2010 Sep 10.
Dopamine (DA) is a catecholamine with a wide range of functions and whose five subtype receptors are found in different organs where they exert a mainly inhibitory action. Since this action may also appear in a number of secretory tumors in various locations, DA agonists have elicited some interest as a medical treatment for hypercorticism. Non-iatrogenic Cushing's syndromes are due in 70% of the cases to a pituitary adrenocorticotropic hormone (ACTH)-producing adenoma, and, less frequently, to an adrenal adenoma or an ectopic ACTH secretion by a neuroendocrine tumor. First-line treatment in Cushing's syndrome consists of the surgical removal of the secreting tumor. However, surgery may not achieve a complete cure in a number of cases, hence emphasizing the potential benefit of a medical complementary treatment, which could also benefit patients as an alternative approach, either when waiting for, or when the patient is not eligible for surgery. Studies of corticotropic adenomas have shown that 80% of these tumors express D2 receptors. Clinical trials of DA agonists in Cushing's disease have shown an inhibitory effect of these drugs with an inhibition of ACTH secretion and/or a decrease of tumor size. There are only a few cases of documented use of DA agonists in ectopic ACTH secretion, but when the tumor expresses DA receptors, DA agonists may represent a useful complementary treatment. DA receptors are also expressed in normal and tumoral adrenals, suggesting a potential use of DA agonists in Cushing's syndrome secondary to adrenal tumors. However, clinical data regarding this specific situation are very scarce, maybe due to the relatively high rate of surgical cure of adrenal adenomas. In conclusion, DA agonists represent a potential preparatory or complementary treatment for endogenous Cushing's syndrome, especially in Cushing's disease. These compounds may be underused as suggested by the scarce number of publication and case reports in the literature. In the future, association of these drugs with somatostatin analogs may also prove beneficial.
多巴胺（DA）是一种儿茶酚胺，具有广泛的功能，其五种亚型受体存在于不同的器官中，在这些器官中发挥主要的抑制作用。由于这种作用也可能出现在各种部位的许多分泌性肿瘤中，因此多巴胺激动剂作为皮质醇过多症的治疗方法引起了一些关注。非医源性库欣综合征在 70%的病例中是由于垂体促肾上腺皮质激素（ACTH）分泌腺瘤引起的，较少见的是由于肾上腺腺瘤或神经内分泌肿瘤的异位 ACTH 分泌引起的。库欣综合征的一线治疗方法是手术切除分泌肿瘤。然而，在许多情况下，手术可能无法完全治愈，因此强调了医学辅助治疗的潜在益处，这也可以为患者提供替代治疗方法，无论是在等待手术时，还是患者不符合手术条件时。对促皮质激素腺瘤的研究表明，这些肿瘤中有 80%表达 D2 受体。DA 激动剂在库欣病中的临床试验表明，这些药物具有抑制作用，可抑制 ACTH 分泌和/或缩小肿瘤体积。只有少数关于异位 ACTH 分泌中 DA 激动剂使用的记录病例，但当肿瘤表达 DA 受体时，DA 激动剂可能代表一种有用的辅助治疗方法。DA 受体也在正常和肿瘤肾上腺中表达，这表明 DA 激动剂在肾上腺肿瘤引起的库欣综合征中具有潜在的用途。然而，关于这种特殊情况的临床数据非常有限，可能是由于肾上腺腺瘤的手术治愈率相对较高。总之，DA 激动剂代表了内源性库欣综合征的一种潜在的预备或辅助治疗方法，尤其是在库欣病中。这些化合物的使用可能不足，这反映在文献中发表的出版物和病例报告数量较少。在未来，这些药物与生长抑素类似物的联合使用也可能证明是有益的。
