AACE/ACE Disease State Clinical Review: Medical Management of Cushing Disease.

Abstract

OBJECTIVE:

To review available medical therapies for patients with Cushing disease and to provide a roadmap for their use in clinical practice.

METHODS:

PubMed searches were performed to identify all of the available published data on medical management of Cushing disease.

RESULTS:

Medical therapy is usually not the first-line treatment for patients with Cushing disease but may be used to improve clinical manifestations of Cushing disease in patients who are not suitable candidates for surgery, following unsuccessful surgery or recurrence, or as a "bridge therapy" in those who have undergone radiotherapy. Medical therapy may also be used in preoperative preparation of patients with severe disease. Current available medical options for patients with Cushing disease include centrally acting agents, steroidogenesis inhibitors, and a glucocorticoid receptor antagonists. At present, there are no head-to-head studies comparing the efficacy, tolerability, and safety of different U.S. Food and Drug Administration (FDA)- and non-FDA-approved drugs in patients with Cushing disease. With the initiation of new studies and the completion of ongoing clinical trials, the number of FDA-approved drugs for medical treatment of Cushing disease is expected to increase.

CONCLUSION:

Medical therapy has an important adjunctive role in the management of patients with Cushing disease. The decision to initiate medical treatment depends on many factors, including patient characteristics and preference. Long-term studies are needed to better define the clinical efficacy, safety, and tolerability of medical treatment of Cushing disease, including the role of combination therapies.

• Authors: Amir H Hamrahian, Kevin C J Yuen, Andrew R Hoffman, AACE Neuroendocrine And Pituitary Scientific Committee
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 20 Issue 7 Pg. 746-57 (Jul 2014) ISSN: 1530-891X [Print] United States
• PMID: 25057099 (Publication Type: Journal Article, Review)

Chemical References

• Ergolines
• Mifepristone
• Somatostatin
• Adrenocorticotropic Hormone
• pasireotide
• Cabergoline
• Ketoconazole

Topics

• Adrenocorticotropic Hormone (metabolism)
• Cabergoline
• Drug Therapy, Combination
• Ergolines (therapeutic use)
• Humans
• Ketoconazole (therapeutic use)
• Mifepristone (therapeutic use)
• Pituitary ACTH Hypersecretion (drug therapy, metabolism)
• Somatostatin (analogs & derivatives, therapeutic use)