title: New prospects for drug treatment in Cushing disease.
abstract: Hypercortisolism induced by Cushing disease causes high morbidity and mortality. The treatment of choice is pituitary surgery, but it often fails to achieve cure, and other treatment modalities (radiotherapy, bilateral adrenalectomy) may therefore be required. If these treatments are not effective or while waiting for their results, hypercortisolism should be controlled with drugs. The classical drug treatments are those that act by inhibiting cortisol secretion by the adrenal gland (ketoconazole, metyrapone, mitotane, etomidate). The preliminary results of a new drug (LCI699) which is a potent enzyme inhibitor of cortisol secretion have been reported. A clinical trial of the safety and efficacy of mifepristone, a glucocorticoid receptor antagonist, has just been published. The drugs deserving more attention today are those with a direct action on the tumor by inhibiting ACTH secretion: somatostatin analogues (pasireotide), dopamine agonists (cabergoline), PPAR-γ, and retinoic acid. A special review is made of the available clinical trials with pasireotide and cabergoline.
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: María-José
authors.initials: MJ
authors.lastname: Barahona Constanzo
authors.forename: Carlos
authors.initials: C
authors.lastname: del Pozo Picó
mesh_terms: D000236:Adenoma / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000818:Animals; D000077465:Cabergoline; D002986:Clinical Trials as Topic; D017326:Clinical Trials, Phase III as Topic; D004353:Drug Evaluation, Preclinical; D004873:Ergolines / Q000627:therapeutic use; D005045:Etomidate / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007093:Imidazoles / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D008797:Metyrapone / Q000627:therapeutic use; D051379:Mice; D015735:Mifepristone / Q000627:therapeutic use; D008939:Mitotane / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D047495:PPAR gamma / Q000819:agonists; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy* / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000378:metabolism; D011725:Pyridines / Q000627:therapeutic use; D051381:Rats; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D035703:Therapies, Investigational; D014212:Tretinoin / Q000627:therapeutic use
chemical_list: D004873:Ergolines; D007093:Imidazoles; D047495:PPAR gamma; D011725:Pyridines; D015735:Mifepristone; D013004:Somatostatin; D014212:Tretinoin; C553306:Osilodrostat; D008939:Mitotane; D000324:Adrenocorticotropic Hormone; C517782:pasireotide; D000077465:Cabergoline; D007654:Ketoconazole; D006854:Hydrocortisone; D005045:Etomidate; D008797:Metyrapone