Sustained Remission of Nelson's Syndrome after Stopping Cyproheptadine Treatment

Cyproheptadine treatment in some patients with Cushing's disease or Nelson's syndrome results in amelioration of the clinical symptoms, a decrease in the range of plasma levels of adrenocorticotropin (ACTH), restoration of normal periodicity of plasma concentrations of ACTH, and reversal of the anomalous ACTH response to thyrotropin releasing hormone.1 2 3 4 Such treatment is based on cyproheptadine's antiserotoninergic actions, since serotonin has a role in the release of corticotropin releasing factor5 and in the mediation of circadian periodicity of corticosteroid concentrations.6 Relapse occurs when the drug is discontinued.1 In this report, we describe a patient with Nelson's syndrome in whom clinical and . . .