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
...Treatment...
...Treatment Goals for...
...ith overt CS, the Endocrine Societ...
...nds against treatment to reduce cortisol levels...
...gainst treatments designed to normalize corti...
...Optimal...
...ds providing education to patients and...
...ds that all patients receive monitoring and adju...
ES recommends that a multidisciplin...
...suggests evaluating CS patients for risk fac...
In patients with CS undergoing surgery, ES sug...
...that clinicians discuss and offer age...
...First-line Treatmen...
...nitial resection of primary lesion(...
...ends unilateral resection by an experienced adrena...
...S recommends localizing and resecting ectopic AC...
...transsphenoidal selective adenomectom...
...recommends measuring serum sodium severa...
...ends assessing free thyroxine and prol...
...ecommends obtaining a postoperative pi...
...recommends surgical resection of bilateral ad...
...Remission and Recurr...
...an individualized management approa...
...ecommends additional treatments in patien...
...measuring late-night salivary or serum corti...
...using tests to screen for hypercortisolism to a...
...Gluc...
...hat hypocortisolemic patients recei...
...commends follow-up morning cortisol...
...re-evaluating the need for treatment of other...
...Second-line...
...s with ACTH-dependent CS who underwe...
...s bilateral adrenalectomy for occult or metasta...
...nds regularly evaluating for corticotroph tum...
...Repeat...
...ts repeat transsphenoidal surgery, parti...
...Radiation The...
...ends confirming that medical therapy is effe...
ES suggests RT/radiosurgery in patients who hav...
...recommends using RT where there are conce...
...mends measuring serum cortisol or UF...
...Medical...
...recommends steroidogenesis inhibitors u...
...pituitary-directed medical treatments in patients...
...ministering a glucocorticoid antagonist in...
...targeted therapies to treat ectopic ACTH sy...
...Special Population...
...urgent treatment (within 24-72 hours) o...
...ted disorder(s) should be addressed as wel...
...treating the specific comorbidities associated...
...nds educating patients and families...
...patients with adrenal adenoma, ES...
...patients with adrenal adenoma, ES suggests foll...
...hat patients with Carney complex ha...
.... Suggested Algorithm for the Trea...
...cal Treatment of Cushing’s Syndrome...