Advances in the Medical Treatment of Cushing Disease

• Autores: Nicholas A. Tritos, Beverly M.K. Biller
• Localización: Endocrinology and metabolism clinics of North America, ISSN 0889-8529, Vol. 49, Nº. 3, 2020 (Ejemplar dedicado a: Pituitary Disorders), págs. 401-412
• Idioma: inglés
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• Resumen

  • Cushing disease (CD) is caused by a corticotropin (ACTH)-secreting pituitary adenoma (or rarely carcinoma) and requires meticulous management to minimize excess morbidity and mortality associated with hypercortisolism.1–4 Transsphenoidal pituitary surgery, performed by an experienced pituitary neurosurgeon, is the cornerstone of treatment of most patients with CD.5–7 However, about 15% of patients with CD donot achieve remission after transsphenoidal pituitary surgery.6,8 In addition, approximately 2% of patients recur annually after achieving surgical remission, leading to a cumulative recurrence rate that approaches 35% on long-term follow-up.9 Medical therapy is typically adjunctive in patients with CD.5,10 It is generally administered to those who have recurred after surgery or patients who did not achieve remission postoperatively and are not considered repeat surgical candidates. In this group of patients, pituitary radiotherapy is frequently advised as definitive treatment, whereas medical therapy serves to control hypercortisolism until radiotherapy takes effect (after a period of months to years)