title: AACE/ACE Disease State Clinical Review: Medical Management of Cushing Disease.
abstract: OBJECTIVE
  To review available medical therapies for patients with Cushing disease and to provide a roadmap for their use in clinical practice.
  
  
  METHODS
  PubMed searches were performed to identify all of the available published data on medical management of Cushing disease.
  
  
  RESULTS
  Medical therapy is usually not the first-line treatment for patients with Cushing disease but may be used to improve clinical manifestations of Cushing disease in patients who are not suitable candidates for surgery, following unsuccessful surgery or recurrence, or as a "bridge therapy" in those who have undergone radiotherapy. Medical therapy may also be used in preoperative preparation of patients with severe disease. Current available medical options for patients with Cushing disease include centrally acting agents, steroidogenesis inhibitors, and a glucocorticoid receptor antagonists. At present, there are no head-to-head studies comparing the efficacy, tolerability, and safety of different U.S. Food and Drug Administration (FDA)- and non-FDA-approved drugs in patients with Cushing disease. With the initiation of new studies and the completion of ongoing clinical trials, the number of FDA-approved drugs for medical treatment of Cushing disease is expected to increase.
  
  
  CONCLUSIONS
  Medical therapy has an important adjunctive role in the management of patients with Cushing disease. The decision to initiate medical treatment depends on many factors, including patient characteristics and preference. Long-term studies are needed to better define the clinical efficacy, safety, and tolerability of medical treatment of Cushing disease, including the role of combination therapies.
authors: Department of Endocrinology, Diabetes and Metabolism, Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Amir H
authors: AH
authors: Hamrahian
authors: Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health and Science University, Portland Oregon.
authors: Kevin C J
authors: KC
authors: Yuen
authors: Department of Medicine, VA Palo Alto Health Care Service and Stanford University School of Medicine, Palo Alto, California.
authors: Andrew R
authors: AR
authors: Hoffman
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000077465:Cabergoline; D004359:Drug Therapy, Combination; D004873:Ergolines / Q000627:therapeutic use; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D015735:Mifepristone / Q000627:therapeutic use; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy* / Q000378:metabolism; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D004873:Ergolines; D015735:Mifepristone; D013004:Somatostatin; D000324:Adrenocorticotropic Hormone; C517782:pasireotide; D000077465:Cabergoline; D007654:Ketoconazole