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
...ls for Cushing’s Syndrome...
...tients with overt CS, the Endocrine Society (ES) r...
ES recommends against treatment to reduce...
...against treatments designed to normalize cor...
...l Adjunctive Manageme...
...ds providing education to patients...
...at all patients receive monitoring and...
...recommends that a multidisciplinary te...
...sts evaluating CS patients for ris...
...tients with CS undergoing surgery, ES sugg...
...ds that clinicians discuss and offer age-app...
...-line Treatment Options...
...ommends initial resection of primary lesion(s) und...
...S recommends unilateral resection by...
...recommends localizing and resecting...
...mmends transsphenoidal selective adenomectomy (TSS...
...recommends measuring serum sodium several...
...ds assessing free thyroxine and prolactin...
...nds obtaining a postoperative pitui...
...ommends surgical resection of bilateral adrenal d...
...currence After Surgical Tumor Resection...
...individualized management approach based...
...ds additional treatments in patients with pers...
...nds measuring late-night salivary or serum cort...
...nds using tests to screen for hypercor...
...oid Replacement and Discontinuation, and Resolut...
...hat hypocortisolemic patients receive glu...
...ollow-up morning cortisol and/or ACTH sti...
...s re-evaluating the need for treatment...
Second-line Therapeuti...
...ith ACTH-dependent CS who underwent a non-curative...
...suggests bilateral adrenalectomy for occult or...
...ends regularly evaluating for corticotroph tumor p...
Repeat Transsphenoidal...
...ests repeat transsphenoidal surgery, particularly...
...py/Radiosurgery for Cushing's Disease...
...onfirming that medical therapy is effective in no...
...suggests RT/radiosurgery in patient...
...ing RT where there are concerns abou...
...mends measuring serum cortisol or UFC...
Medical Rx
...teroidogenesis inhibitors under the following c...
...suggests pituitary-directed medical treatments i...
...dministering a glucocorticoid antagoni...
...uggests targeted therapies to treat ectopic ACTH...
Special Populations/Con...
...mends urgent treatment (within 24-72 hours)...
...ciated disorder(s) should be addressed as well...
...or Long-term Follow-up...
...reating the specific comorbidities a...
ES recommends educating patients and families...
...ith adrenal adenoma, ES suggests f...
...ents with adrenal adenoma, ES suggests fo...
...ends that patients with Carney complex...
...ted Algorithm for the Treatment of Cushing’s...
...edical Treatment of Cushing’s Syndrom...