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2016 ; 2
(ä): 16
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Update on medical treatment for Cushing s disease
#MMPMID28702250
Cuevas-Ramos D
; Lim DST
; Fleseriu M
Clin Diabetes Endocrinol
2016[]; 2
(ä): 16
PMID28702250
show ga
Cushing's disease (CD) is the most common cause of endogenous Cushing's syndrome
(CS). The goal of treatment is to rapidly control cortisol excess and achieve
long-term remission, to reverse the clinical features and reduce long-term
complications associated with increased mortality. While pituitary surgery
remains first line therapy, pituitary radiotherapy and bilateral adrenalectomy
have traditionally been seen as second-line therapies for persistent
hypercortisolism. Medical therapy is now recognized to play a key role in the
control of cortisol excess. In this review, all currently available medical
therapies are summarized, and novel medical therapies in phase 3 clinical trials,
such as osilodrostat and levoketoconazole are discussed, with an emphasis on
indications, efficacy and safety. Emerging data suggests increased efficacy and
better tolerability with these novel therapies and combination treatment
strategies, and potentially increases the therapeutic options for treatment of
CD. New insights into the pathophysiology of CD are highlighted, along with
potential therapeutic applications. Future treatments on the horizon such as
R-roscovitine, retinoic acid, epidermal growth factor receptor inhibitors and
somatostatin-dopamine chimeric compounds are also described, with a focus on
potential clinical utility.
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