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

Treatment

...Goals for Cushing’s Syndrome...

...atients with overt CS, the Endocrine Society (ES)...

...S recommends against treatment to r...

...suggests against treatments designed to...


...timal Adjunctive Management...

...roviding education to patients and their family...

...mends that all patients receive monitori...

...S recommends that a multidisciplinary...

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

...ients with CS undergoing surgery, ES suggests...

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


...st-line Treatment Options...

ES recommends initial resection of pri...

...nds unilateral resection by an experienced a...

...calizing and resecting ectopic ACTH-secreting...

...nds transsphenoidal selective adenomectomy (T...

...mends measuring serum sodium several ti...

...mmends assessing free thyroxine and prolactin...

...s obtaining a postoperative pituitary MR...

...S recommends surgical resection of bila...


...on and Recurrence After Surgical T...

...an individualized management approach...

...nds additional treatments in patien...

...s measuring late-night salivary or serum c...

...commends using tests to screen for...


Glucocorticoid Replacement and Discon...

...ends that hypocortisolemic patients receive gluco...

...mmends follow-up morning cortisol and/or...

...recommends re-evaluating the need for...


...ine Therapeutic Options

...tients with ACTH-dependent CS who...

...ts bilateral adrenalectomy for occult or...

...ends regularly evaluating for corticotroph...


...nssphenoidal Surgery...

...suggests repeat transsphenoidal surgery, partic...


...apy/Radiosurgery for Cushing's...

...s confirming that medical therapy is e...

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

...commends using RT where there are con...

...asuring serum cortisol or UFC off-medicat...


...edical Rx

...ommends steroidogenesis inhibitors...

...uggests pituitary-directed medical treatmen...

...administering a glucocorticoid antago...

...argeted therapies to treat ectopic ACTH syndrome...


...ial Populations/Considerations

...ecommends urgent treatment (within...

...iated disorder(s) should be addressed as well...


...ach for Long-term Follow-...

...ommends treating the specific comorbidities associ...

...ommends educating patients and families about the...

...s with adrenal adenoma, ES suggest...

...ients with adrenal adenoma, ES suggests follo...

...mends that patients with Carney complex...


Figure 1. Suggested Algorithm for the...


...1. Medical Treatment of Cushing’s Syndrom...