Cushing's syndrome medical therapy: Difference between revisions
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*[[Mitotane]] | *[[Mitotane]] | ||
*[[Mifepristone]] | *[[Mifepristone]] | ||
The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost.<ref name="urlTreatment of Cushings Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url= | The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost.<ref name="urlTreatment of Cushings Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://doi.org/10.1210/jc.2015-1818 |title=Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |format= |work= |accessdate=}}</ref> | ||
===Drug regimen=== | ===Drug regimen=== | ||
Drug regimens used for the treatment of Cushing's syndrome are: <ref name="pmid26004339">{{cite journal |vauthors=Lacroix A, Feelders RA, Stratakis CA, Nieman LK |title=Cushing's syndrome |journal=Lancet |volume=386 |issue=9996 |pages=913–27 |year=2015 |pmid=26004339 |doi=10.1016/S0140-6736(14)61375-1 |url=}}</ref> | Drug regimens used for the treatment of Cushing's syndrome are: <ref name="pmid26004339">{{cite journal |vauthors=Lacroix A, Feelders RA, Stratakis CA, Nieman LK |title=Cushing's syndrome |journal=Lancet |volume=386 |issue=9996 |pages=913–27 |year=2015 |pmid=26004339 |doi=10.1016/S0140-6736(14)61375-1 |url=}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The medications usually used for the treatment of Cushing's syndrome are Pasireotide, Cabergoline, Ketoconazole and Metyrapone.
Medical therapy
Indications for medical treatment of Cushing's syndrome include:[1]
- Acute complications of hypercortisolism (psychosis, and infection).
- Surgery pretreatment in severe cases if surgery is delayed.
- Hypercortisolism after unsuccessful surgery, while awaiting control from radiotherapy.
- Unresectable or metastatic tumors.
- Hypercortisolism due to an occult ectopic ACTH-producing neuroendocrine tumor.
The medications usually used for the treatment of Cushing's syndrome are:[2]
The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost.[3]
Drug regimen
Drug regimens used for the treatment of Cushing's syndrome are: [2]
- Drug regimen 1:Ketoconazole 400–1600 mg per day orally
- Drug regimen 2:Mifepristone 300–1200 mg per day orally
- Drug regimen 3:Metyrapone 0·5–4·5 g per day orally
- Drug regimen 4:Pasireotide 750–2400 μg per day subcutaneously injected
- Drug regimen 5:Cabergoline Up to 7 mg per week orally
- Drug regimen 6:Mitotane 3–5 g per day orally
It is important to remember that the vast majority of cases of Cushing's syndrome are caused by steroid medications (such causes are described as iatrogenic) so a review of medications first, as stopping or reducing the dose can usually resolve the problem.
References
- ↑ van der Pas R, de Herder WW, Hofland LJ, Feelders RA (2012). "New developments in the medical treatment of Cushing's syndrome". Endocr. Relat. Cancer. 19 (6): R205–23. doi:10.1530/ERC-12-0191. PMID 22936543.
- ↑ 2.0 2.1 Lacroix A, Feelders RA, Stratakis CA, Nieman LK (2015). "Cushing's syndrome". Lancet. 386 (9996): 913–27. doi:10.1016/S0140-6736(14)61375-1. PMID 26004339.
- ↑ "Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".