Pharmacological management of Cushing's syndrome: an update.
The treatment of choice for Cushing's syndrome remains surgical. The role for medical therapy is twofold. Firstly it is used to control hypercortisolaemia prior to surgery to optimize patient's preoperative state and secondly, it is used where surgery has failed and radiotherapy has not taken effect. The main drugs used inhibit steroidogenesis and include metyrapone, ketoconazole, and mitotane. Drugs targeting the hypothalamic-pituitary axis have been investigated but their roles in clinical practice remain limited although PPAR-gamma agonist and somatostatin analogue som-230 (pasireotide) need further investigation. The only drug acting at the periphery targeting the glucocorticoid receptor remains Mifepristone (RU486). The management of Cushing syndrome may well involve combination therapy acting at different pathways of hypercortisolaemia but monitoring of therapy will remain a challenge.
Dang
Cuong Nguyen
CN
Christie Hospital, Manchester, UK.
Trainer
Peter
P
D003480:Cushing Syndrome / Q000188:drug therapy*; D018492:Dopamine Antagonists / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D007654:Ketoconazole / Q000627:therapeutic use; D008797:Metyrapone / Q000627:therapeutic use; D015735:Mifepristone / Q000627:therapeutic use; D008939:Mitotane / Q000627:therapeutic use; D047495:PPAR gamma / Q000819:agonists; D010913:Pituitary-Adrenal System / Q000187:drug effects; D013004:Somatostatin / Q000031:analogs & derivatives; D013256:Steroids / Q000037:antagonists & inhibitors / Q000096:biosynthesis
D018492:Dopamine Antagonists; D006727:Hormone Antagonists; D047495:PPAR gamma; D013256:Steroids; D015735:Mifepristone; D013004:Somatostatin; D008939:Mitotane; D007654:Ketoconazole; D008797:Metyrapone