Cushing's disease: role of preoperative and primary medical therapy. 2022

Frederic Castinetti
Department of Endocrinology, Assistance Publique-Hopitaux de Marseille, INSERM, Marseille Medical Genetics, Marmara Institute, French Reference Center for Rare Pituitary Diseases, Endo-European Reference Network and EURACAN European Expert Center on Rare Pituitary Tumors, La Conception Hospital, Aix Marseille University, 147 Boulevard Baille, 13385, Marseille Cedex 05, France. Frederic.castinett@ap-hm.fr.

Transsphenoidal surgery is the first-line treatment for Cushing's disease. However, some situations may require the use of a primary medical treatment, such as in patients with severe life-threatening hypercortisolism, a situation which can be handled by fast-acting steroidogenesis inhibitors, instead of classical bilateral adrenalectomy. Primary medical treatment could also be considered in patients with non-severe hypercortisolism, but the evidence is far less convincing for its systematic use. The aim of this short review is to explain briefly the different circumstances in which primary medical therapy could be considered, the limits of this approach, and the way in which to initiate and monitor the treatment.

UI MeSH Term Description Entries
D003480 Cushing Syndrome A condition caused by prolonged exposure to excess levels of cortisol (HYDROCORTISONE) or other GLUCOCORTICOIDS from endogenous or exogenous sources. It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid. Endogenous Cushing syndrome or spontaneous hypercortisolism is divided into two groups, those due to an excess of ADRENOCORTICOTROPIN and those that are ACTH-independent. Cushing's Syndrome,Hypercortisolism,Syndrome, Cushing,Syndrome, Cushing's
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000315 Adrenalectomy Excision of one or both adrenal glands. (From Dorland, 28th ed) Adrenalectomies
D047748 Pituitary ACTH Hypersecretion A disease of the PITUITARY GLAND characterized by the excess amount of ADRENOCORTICOTROPIC HORMONE secreted. This leads to hypersecretion of cortisol (HYDROCORTISONE) by the ADRENAL GLANDS resulting in CUSHING SYNDROME. Cushing Disease,Cushing's Disease,Inappropriate ACTH Secretion Syndrome,Inappropriate Adrenocorticotropic Hormone Secretion,Adrenocorticotropic Hormone, Inappropriate Secretion,Cushing Disease, Pituitary,Pituitary Cushing Syndrome,Pituitary-Dependant Cushing Syndrome,Pituitary-Dependant Hypercortisolism,Pituitary-Dependant Hypercortisolism Disorder,Cushing Syndrome, Pituitary,Cushing Syndrome, Pituitary-Dependant,Disease, Cushing,Hypercortisolism Disorder, Pituitary-Dependant,Hypercortisolism, Pituitary-Dependant,Hypersecretion, Pituitary ACTH,Pituitary Cushing Disease,Pituitary Dependant Cushing Syndrome,Pituitary Dependant Hypercortisolism,Pituitary Dependant Hypercortisolism Disorder,Pituitary-Dependant Hypercortisolism Disorders,Pituitary-Dependant Hypercortisolisms
D065088 Steroid Synthesis Inhibitors Compounds that bind to and inhibit enzymes involved in the synthesis of STEROIDS. Adrenal Steroid Synthesis Inhibitors,Androgen Synthesis Inhibitors,Estrogen Synthesis Inhibitors,Glucocorticoid Synthesis Inhibitors,Mineralocorticoid Synthesis Inhibitors,Progestin Synthesis Inhibitors,Sex Hormone Synthesis Inhibitors,Steroid Synthesis Antagonists,Steroid Synthesis Blockers,Antagonists, Steroid Synthesis,Blockers, Steroid Synthesis,Inhibitors, Androgen Synthesis,Inhibitors, Estrogen Synthesis,Inhibitors, Glucocorticoid Synthesis,Inhibitors, Mineralocorticoid Synthesis,Inhibitors, Progestin Synthesis,Inhibitors, Steroid Synthesis,Synthesis Antagonists, Steroid,Synthesis Blockers, Steroid,Synthesis Inhibitors, Androgen,Synthesis Inhibitors, Estrogen,Synthesis Inhibitors, Glucocorticoid,Synthesis Inhibitors, Mineralocorticoid,Synthesis Inhibitors, Progestin,Synthesis Inhibitors, Steroid

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