Cushing's Syndrome Treatment
Key Points
Key Points
- Treatment of Cushing’s syndrome (CS) is essential to reduce mortality and associated comorbidities.
- Effective treatment includes the normalization of cortisol levels or action. It also includes the normalization of comorbidities via directly treating the cause of CS and by adjunctive treatments (e.g., antihypertensives).
- Surgical resection of the causal lesion(s) is generally the first-line approach.
- The choice of second-line treatments, including medication, bilateral adrenalectomy, and RT (for corticotroph tumors), must be individualized to each patient.
Treatment
Treatm...
...ment Goals for Cushing’s Syndrome...
In patients with overt CS, the Endocrin...
...ecommends against treatment to reduce cortis...
...gests against treatments designed to normal...
...djunctive Management...
...ommends providing education to patients a...
...that all patients receive monitoring and adj...
...ds that a multidisciplinary team, including an ex...
...evaluating CS patients for risk fa...
...n patients with CS undergoing surgery...
ES recommends that clinicians discuss and offer...
...e Treatment Options...
...recommends initial resection of primar...
...ilateral resection by an experienced adre...
...recommends localizing and resectin...
...S recommends transsphenoidal selective aden...
...mends measuring serum sodium several ti...
...sessing free thyroxine and prolactin...
...ends obtaining a postoperative pitui...
...S recommends surgical resection of bilatera...
...mission and Recurrence After Surgical Tumo...
...ts an individualized management approach based on...
...dditional treatments in patients wit...
...nds measuring late-night salivary or s...
...ends using tests to screen for hypercortisolism...
...id Replacement and Discontinuation, and Res...
...commends that hypocortisolemic patients re...
...mmends follow-up morning cortisol and/or...
...mends re-evaluating the need for treatment of...
...ne Therapeutic Options...
...with ACTH-dependent CS who underwent a non-...
...teral adrenalectomy for occult or metastatic EAS...
...recommends regularly evaluating for corticotroph...
...ranssphenoidal Surgery...
...sts repeat transsphenoidal surgery, particularly...
...ation Therapy/Radiosurgery for Cushing&#...
...nds confirming that medical therapy is...
...S suggests RT/radiosurgery in patients who have...
...s using RT where there are concerns about the ma...
...measuring serum cortisol or UFC off-medi...
...dical Rx...
...teroidogenesis inhibitors under the following co...
...ests pituitary-directed medical treat...
...nistering a glucocorticoid antagonist...
ES suggests targeted therapies to treat ect...
...l Populations/Considerations...
...gent treatment (within 24-72 hours) of hy...
...e associated disorder(s) should be address...
Approach for Long-term...
...mends treating the specific comorbidities...
...ends educating patients and families about t...
...ients with adrenal adenoma, ES suggests follow-u...
...h adrenal adenoma, ES suggests follow-up...
...commends that patients with Carney complex hav...
...gure 1. Suggested Algorithm for the Treatment of...
.... Medical Treatment of Cushing’s Synd...