Treatment of Cushing’s syndrome

(JCEM 2015;100:2807. J Intern Med 2019;286:526)

Surgical

一線治療

• resection of pituitary adenoma,
• adrenal tumor or ectopic ACTH-secreting tumor,
• or bilateral surgical adrenalectomy if unable to control source of ACTH

Medical

• ketoconazole
• metyrapone
• osilodrostat
• cabergoline
• pasireotide
• mitotane to ↓ cortisol,
• and/or mifepristone to block cortisol action at glucocorticoid receptor
• frequently used as bridge to surgery or when surgery contraindicated

Radiation

• can do pituitary XRT, but not effective immediately (takes 6 mo to 2 y)

Glucocorticoid replacement therapy

• × 6–36 mo after TSS (lifelong glucocorticoid + mineralocorticoid replacement if medical or surgical adrenalectomy)