[The medical management of Cushing's syndrome].
Cushing's syndrome results from prolonged exposure to excessive circulating glucocorticosteroids and is associated with significant morbidity and mortality. While the treatment of choice in most patients is surgical, the metabolic consequences of this syndrome, including hypertension and diabetes mellitus, increase the risks of such surgery. Hypercortisolemia and its sequelae can be efficiently reversed or controlled using medical therapy, either as a temporary measure prior to definitive treatment or as a longer-term treatment in some particularly difficult cases. Drug treatment has been targeted at the hypothalamic/pituitary level, the adrenal glands and at glucocorticoid receptors. The present review discusses the pharmacotherapeutic agents that have been used in Cushing's syndrome and the criteria for their use, as well as recent drugs that may improve the medical treatment of this complex endocrinological disorder in the future. Finally, the short-and long-term follow-up of patients with Cushing's syndrome after surgery is also discussed.
Leal-Cerro
Alfonso
A
Instituto de Biomedicina de Sevilla. I/CSIC/Universidad de Sevilla y Unidad de Gestión de Endocrinología. Hospital Universitario Virgen del Rocío. Sevilla. España. aleal@ibis-sevilla.es
Soto Moreno
Alfonso
A
Mangas
Miguel Angel
MA
León Justel
Antonio
A
Webb
Susan
S
D000302:Adrenal Cortex / Q000187:drug effects / Q000378:metabolism; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000616:Aminoglutethimide / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003480:Cushing Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D018491:Dopamine Agonists / Q000627:therapeutic use; D005938:Glucocorticoids / Q000037:antagonists & inhibitors; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D007016:Hypophysectomy; D007093:Imidazoles / Q000627:therapeutic use; D008939:Mitotane / Q000627:therapeutic use; D010903:Pituitary Gland, Anterior / Q000187:drug effects / Q000378:metabolism; D000077154:Rosiglitazone; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use
D018491:Dopamine Agonists; D005938:Glucocorticoids; D007093:Imidazoles; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D000616:Aminoglutethimide; D013004:Somatostatin; D008939:Mitotane; D000324:Adrenocorticotropic Hormone; C517782:pasireotide; D006854:Hydrocortisone