A case of cushing syndrome of undetermined cause managed medically with cabergoline

We report a 77 year old lady with hypertension and hypokalaemic metabolic alkalosis who was found to have ACTH dependant Cushing Syndrome (CS). Cortisol level was not suppressed during low dose as well as high dose dexamethazone suppression test (HDDST). Her pituitary MRI was normal and inferior petrosal sinus sampling was consistent with ectopic ACTH secretion. CECT of the abdomen and chest was normal. She was started on medical treatment with a plan of re-imaging during the follow-up. As she couldn’t tolerate ketoconazole and since our options were limited, she was started on Cabergoline to which she has shown a good response until the time of this report. Cabergoline has been reported to show varying efficacy according to the available literature. This report highlights the efficacy of cabergoline in this selected case of CS.