Abstract
Context: Cushing's disease (CD) is associated with serious morbidity and, when suboptimally treated, an increased mortality. Although surgery is the first-line treatment modality for CD, hypercortisolism persists or recurs in an important subset of patients. Considering the deleterious effects of uncontrolled CD, there is a clear need for effective medical therapy. Objective: In this review, wediscuss molecular targets for medical therapy, efficacy, and side effects of the currently used drugs to treat hypercortisolism and focus on recent developments resulting from translational and clinical studies. Evidence Acquisition: Selection of publications related to the study objective was performed via a PubMed search using relevant keywords and search terms. Main Findings: Medical therapy for CD can be classified into pituitary-directed, adrenal-blocking, and glucocorticoid receptor-antagonizing drugs. Recent studies demonstrate that somatostatin receptor subtype 5 (sst(5)) and dopamine receptor subtype 2 (D-2) are frequently (co-) expressed by corticotroph adenomas. Pituitary-directed therapy with pasireotide and cabergoline, targeting sst(5) and D-2, respectively, is successful in approximately 25-30% of patients. Adrenal-blocking drugs can be eff Conclusion: Medical therapy for CD can be targeted at different levels and should be tailored in each individual patient. Future studies should examine the optimal dose and combination of medical treatment modalities for CD. (J Clin Endocrinol Metab 98: 425-438, 2013)
Original language | Undefined/Unknown |
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Pages (from-to) | 425-438 |
Number of pages | 14 |
Journal | Journal of Clinical Endocrinology and Metabolism |
Volume | 98 |
Issue number | 2 |
DOIs | |
Publication status | Published - 2013 |
Research programs
- EMC MM-01-39-01