Treatment of Cushing disease: overview and recent findings

Tatiana Mancini1, Teresa Porcelli2, Andrea Giustina21Department of Internal Medicine and Medical Specialties, San Marino Hospital, San Marino, Republic of San Marino, 2Department of Medical and Surgical Sciences, University of Brescia, Brescia, ItalyAbstract: Endogenous Cushing syndrome is an endocr...

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Autores principales:	Tatiana Mancini, Teresa Porcelli, Andrea Giustina
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/977134d60051428b9848fa82682a2156
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spelling	oai:doaj.org-article:977134d60051428b9848fa82682a21562021-12-02T11:17:24ZTreatment of Cushing disease: overview and recent findings1176-63361178-203Xhttps://doaj.org/article/977134d60051428b9848fa82682a21562010-10-01T00:00:00Zhttp://www.dovepress.com/treatment-of-cushing-disease-overview-and-recent-findings-a5487https://doaj.org/toc/1176-6336https://doaj.org/toc/1178-203XTatiana Mancini1, Teresa Porcelli2, Andrea Giustina21Department of Internal Medicine and Medical Specialties, San Marino Hospital, San Marino, Republic of San Marino, 2Department of Medical and Surgical Sciences, University of Brescia, Brescia, ItalyAbstract: Endogenous Cushing syndrome is an endocrine disease caused by excessive secretion of adrenocorticotropin hormone in approximately 80% of cases, usually by a pituitary corticotroph adenoma (Cushing disease [CD]). It is a heterogeneous disorder requiring a multidisciplinary and individualized approach to patient management. The goals of treatment of CD include the reversal of clinical features, the normalization of biochemical changes with minimal morbidity, and long-term control without recurrence. Generally, the treatment of choice is the surgical removal of the pituitary tumor by transsphenoidal approach, performed by an experienced surgeon. Considering the high recurrence rate, other treatments should be considered. Second-line treatments include more radical surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. Drug treatment has been targeted at the hypothalamic or pituitary level, at the adrenal gland, and also at the glucocorticoid receptor level. Frequently, medical therapy is performed before surgery to reduce the complications of the procedure, reducing the effects of severe hypercortisolism. Commonly, in patients in whom surgery has failed, medical management is often essential to reduce or normalize the hypercortisolemia, and should be attempted before bilateral adrenalectomy is considered. Medical therapy can be also useful in patients with CD while waiting for pituitary radiotherapy to take effect, which can take up to 10 years or more. So far, results of medical treatment of CD have not been particularly relevant; however, newer tools promise to change this scenario. The aim of this review is to analyze the results and experiences with old and new medical treatments of CD and to reevaluate medical therapies for complications of CD and hypopituitarism in patients with cured CD.Keywords: ketoconazole, somatostatin analogs, dopamine agonists, rosiglitazone, Cushing disease, glucocorticoids, hypopituitarism Tatiana ManciniTeresa PorcelliAndrea GiustinaDove Medical PressarticleTherapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol 2010, Iss default, Pp 505-516 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950
spellingShingle	Therapeutics. Pharmacology RM1-950 Tatiana Mancini Teresa Porcelli Andrea Giustina Treatment of Cushing disease: overview and recent findings
description	Tatiana Mancini1, Teresa Porcelli2, Andrea Giustina21Department of Internal Medicine and Medical Specialties, San Marino Hospital, San Marino, Republic of San Marino, 2Department of Medical and Surgical Sciences, University of Brescia, Brescia, ItalyAbstract: Endogenous Cushing syndrome is an endocrine disease caused by excessive secretion of adrenocorticotropin hormone in approximately 80% of cases, usually by a pituitary corticotroph adenoma (Cushing disease [CD]). It is a heterogeneous disorder requiring a multidisciplinary and individualized approach to patient management. The goals of treatment of CD include the reversal of clinical features, the normalization of biochemical changes with minimal morbidity, and long-term control without recurrence. Generally, the treatment of choice is the surgical removal of the pituitary tumor by transsphenoidal approach, performed by an experienced surgeon. Considering the high recurrence rate, other treatments should be considered. Second-line treatments include more radical surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. Drug treatment has been targeted at the hypothalamic or pituitary level, at the adrenal gland, and also at the glucocorticoid receptor level. Frequently, medical therapy is performed before surgery to reduce the complications of the procedure, reducing the effects of severe hypercortisolism. Commonly, in patients in whom surgery has failed, medical management is often essential to reduce or normalize the hypercortisolemia, and should be attempted before bilateral adrenalectomy is considered. Medical therapy can be also useful in patients with CD while waiting for pituitary radiotherapy to take effect, which can take up to 10 years or more. So far, results of medical treatment of CD have not been particularly relevant; however, newer tools promise to change this scenario. The aim of this review is to analyze the results and experiences with old and new medical treatments of CD and to reevaluate medical therapies for complications of CD and hypopituitarism in patients with cured CD.Keywords: ketoconazole, somatostatin analogs, dopamine agonists, rosiglitazone, Cushing disease, glucocorticoids, hypopituitarism
format	article
author	Tatiana Mancini Teresa Porcelli Andrea Giustina
author_facet	Tatiana Mancini Teresa Porcelli Andrea Giustina
author_sort	Tatiana Mancini
title	Treatment of Cushing disease: overview and recent findings
title_short	Treatment of Cushing disease: overview and recent findings
title_full	Treatment of Cushing disease: overview and recent findings
title_fullStr	Treatment of Cushing disease: overview and recent findings
title_full_unstemmed	Treatment of Cushing disease: overview and recent findings
title_sort	treatment of cushing disease: overview and recent findings
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/977134d60051428b9848fa82682a2156
work_keys_str_mv	AT tatianamancini treatmentofcushingdiseaseoverviewandrecentfindings AT teresaporcelli treatmentofcushingdiseaseoverviewandrecentfindings AT andreagiustina treatmentofcushingdiseaseoverviewandrecentfindings
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Treatment of Cushing disease: overview and recent findings

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