The Cushing’s syndrome therapy mifepristone can alleviate a liver condition that often develops along with Cushing’s, a case study suggests.
The disorder, which involves too many fat deposits in the liver, is called non-alcoholic fatty liver disease, or NAFLD.
Researchers examined the case of a 49-year-old woman with Cushing’s syndrome and NAFLD who took mifepristone.
Their study, “Effects of Mifepristone on Nonalcoholic Fatty Liver Disease in a Patient with a Cortisol-Secreting Adrenal Adenoma,” appeared in the journal Case Reports in Endocrinology.
Twenty percent of Cushing’s patients develop NAFLD, which stems from the high levels of the hormone cortisol that are associated with Cushing’s. NAFLD is a common cause of chronic liver disease.
The mechanism through which cortisol causes liver disease is complex, and scientists have yet to fully understand it.
Researchers said the patient had a history of high blood pressure, high fat levels in her blood and an over-abundance of fat deposits in her liver. In addition, her blood sugar levels were so high that doctors classified her as prediabetic.
Her primary doctor referred her to an endocrine specialist because of persistent weight gain that led to obesity.
Two years before, a routine CT scan had shown that the woman had a non-cancerous adrenal gland tumor. This can be a sign of Cushing’s, but at the time doctors found no other features of the disease.
The endocrine specialist conducted hormone tests showing that several measures of the woman’s cortisol levels were high, indicating she had Cushing’s.
Doctors recommended removing the adrenal gland that contained the tumor, but she declined. Instead, she started taking 300 mg of mifepristone a day. Doctors bumped the dose up to 900 mg during the 34 weeks of treatment.
During this time, she lost 16 pounds, and her liver enzyme levels improved to the point that they became normal 20 weeks after the treatment started. In addition, her high blood pressure improved.
Mifepristone is a competitive glucocorticoid receptor antagonist. It works as a Cushing’s therapy by binding to a receptor that cortisol would otherwise bind to. This reduces the harmful effects of too much cortisol in the body.
During the 34 weeks when the patient received mifepristone, her levels of another hormone, ACTH, increased. Its levels are low in Cushing’s patients, indicating that mifepristone also helped alleviate her Cushing’s syndrome.
The results prompted the researchers to write that “mifepristone treatment was associated with dramatic improvement” in the woman’s liver function tests, “as well as improvements in weight and hypertension [high blood pressure].” In fact, her blood pressure improved to the point that doctors took her off medication for that condition.
“The effect of mifepristone on LFTs [liver function tests] was a novel finding and suggests that mifepristone may offer an alternative treatment to surgery in patients with hypercortisolism [elevated cortisol levels] and NAFLD,” the team wrote.