Cushing's Syndrome Treatment

Publication Date: August 1, 2015

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

...eatment...

...ent Goals for Cushing’s S...

...tients with overt CS, the Endocrine Society (E...

...recommends against treatment to reduce cortiso...

...gests against treatments designed...


...Adjunctive Management

...S recommends providing education to patie...

...that all patients receive monitoring...

...ends that a multidisciplinary team,...

...evaluating CS patients for risk factors fo...

...n patients with CS undergoing surg...

...that clinicians discuss and offer age-ap...


...Treatment Options...

...initial resection of primary lesion(s)...

...commends unilateral resection by an exper...

...mends localizing and resecting ectopic ACTH-s...

...s transsphenoidal selective adenomectomy (TSS) by...

...easuring serum sodium several times during the fir...

...mends assessing free thyroxine and prolacti...

...mmends obtaining a postoperative pituitary...

...ecommends surgical resection of bilateral ad...


...currence After Surgical Tumor Resection...

...S suggests an individualized management...

...mends additional treatments in patien...

...SS recommends measuring late-night salivary or...

...ing tests to screen for hypercortisoli...


...orticoid Replacement and Discontinuation, and Reso...

...ends that hypocortisolemic patients receiv...

...follow-up morning cortisol and/or ACTH stim...

...re-evaluating the need for treatment of other p...


...econd-line Therapeutic Options...

...ients with ACTH-dependent CS who u...

...bilateral adrenalectomy for occult or m...

...mends regularly evaluating for corti...


...at Transsphenoidal Surge...

...repeat transsphenoidal surgery, part...


Radiation Therapy/Radiosurgery for Cushin...

...onfirming that medical therapy is eff...

...RT/radiosurgery in patients who have faile...

...recommends using RT where there are concerns ab...

...S recommends measuring serum cortiso...


...dical Rx...

...mmends steroidogenesis inhibitors un...

...uggests pituitary-directed medical treatments in...

...s administering a glucocorticoid antag...

...s targeted therapies to treat ectopic...


...pulations/Considerations

...ommends urgent treatment (within 24-72 h...

...d disorder(s) should be addressed as wel...


...for Long-term Follow-u...

...mends treating the specific comorbiditi...

...mends educating patients and families a...

...ts with adrenal adenoma, ES sugges...

...ts with adrenal adenoma, ES suggest...

...S recommends that patients with Carney co...


...uggested Algorithm for the Treatment of C...


...Treatment of Cushing’s SyndromeHav...