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2018 ; 9
(ä): 164
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Pituitary-Directed Therapies for Cushing s Disease
#MMPMID29765354
Langlois F
; Chu J
; Fleseriu M
Front Endocrinol (Lausanne)
2018[]; 9
(ä): 164
PMID29765354
show ga
Cushing's disease (CD) is caused by a pituitary corticotroph neuroendocrine tumor
inducing uncontrolled hypercortisolism. Transsphenoidal surgery is the first-line
treatment in most cases. Nonetheless, some patients will not achieve cure even in
expert hands, others may not be surgical candidates and a significant percentage
will experience recurrence. Many patients will thus require medical therapy to
achieve disease control. Pharmacologic options to treat CD have increased in
recent years, with an explosion in knowledge related to pathophysiology at the
molecular level. In this review, we focus on medications targeting specifically
pituitary adrenocorticotropic hormone-secreting tumors. The only medication in
this group approved for the treatment of CD is pasireotide, a somatostatin
receptor ligand. Cabergoline and temozolomide may also be used in select cases.
Previously studied and abandoned medical options are briefly discussed, and
emphasis is made on upcoming medications. Mechanism of action and available data
on efficacy and safety of cell cycle inhibitor roscovitine, epidermal growth
factor receptor inhibitor gefitinib, retinoic acid, and silibinin, a heat shock
protein 90 inhibitor are also presented.