Cushing's Syndrome Treatment
Key Points
Key Points
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
...eatment...
...Goals for Cushing’s Syndro...
...nts with overt CS, the Endocrine Society (ES...
...ainst treatment to reduce cortisol...
...suggests against treatments designed to normaliz...
...mal Adjunctive Management...
...commends providing education to patients and t...
...ecommends that all patients receive m...
...mends that a multidisciplinary team, i...
...aluating CS patients for risk factors for venou...
...CS undergoing surgery, ES suggests per...
ES recommends that clinicians discuss...
...rst-line Treatment Options...
...nitial resection of primary lesion(s) un...
...ecommends unilateral resection by an experi...
...S recommends localizing and resect...
...recommends transsphenoidal selecti...
...ds measuring serum sodium several times during...
...ssessing free thyroxine and prolactin within 1–2...
...s obtaining a postoperative pituitary MRI withi...
...ecommends surgical resection of bilateral...
...and Recurrence After Surgical Tumor Resection...
...n individualized management approach based o...
...additional treatments in patients with p...
...mends measuring late-night salivary or seru...
...recommends using tests to screen for h...
...icoid Replacement and Discontinuation, and R...
...S recommends that hypocortisolemic patients recei...
...s follow-up morning cortisol and/or ACTH s...
...re-evaluating the need for treatment...
...ine Therapeutic Options
...ents with ACTH-dependent CS who underwent a...
...uggests bilateral adrenalectomy for...
...mmends regularly evaluating for corticotr...
...epeat Transsphenoidal...
...ests repeat transsphenoidal surgery, particu...
...rapy/Radiosurgery for Cushing's Disease...
...ds confirming that medical therapy is e...
...ts RT/radiosurgery in patients who...
...sing RT where there are concerns about the ma...
...commends measuring serum cortisol or UFC off-med...
...edical Rx
...ends steroidogenesis inhibitors under t...
...ituitary-directed medical treatments i...
...ggests administering a glucocorticoid...
...ts targeted therapies to treat ectopic A...
...l Populations/Considerations...
...mmends urgent treatment (within 24-72 hour...
...ated disorder(s) should be addressed...
...roach for Long-term Follow...
...nds treating the specific comorbiditi...
...ds educating patients and families about the c...
...tients with adrenal adenoma, ES sug...
...th adrenal adenoma, ES suggests follo...
...ends that patients with Carney complex h...
...ggested Algorithm for the Treatmen...
...e 1. Medical Treatment of Cushing’s SyndromeHav...