title: [Indications and future perspectives in the pharmacological treatment of hypercortisolism].
abstract: The hypercortisolism is a rare endocrine disease characterized by an autonomous steroid secretion or excessive adrenal stimulation by ACTH. the Surgical removal of the lesion directly responsible hypercortisolism represents the treatment of choice. When neurosurgery for pituitary adenoma is contraindicated, radiotherapy is candidate as the second line of therapy. Currently, the recent advances in medical therapy provide a viable alternative to surgery and radiotherapy, when these are not feasible or followed by relapses (present in more than one third of cases) of the underlying disease. Recently, also in Italy, are available pharmacological agents with central activity (pasireotide) specifically indicated for treating Cushing's disease together with peripherally acting drugs (metyrapone and ketoconazole) that are used in a broader spectrum of hypercortisolemic clinical pictures. In addition, drugs active in the inhibition of steroidogenesis provide a valid support to the patient's surgical preparation allowing the reduction or normalization of plasma cortisol levels.
authors.affiliation: Endocrinologia, Ospedale Sant'Andrea, Dipartimento di Medicina Clinica e Molecolare, Facoltà di Medicina e Psicologia, Sapienza Università di Roma.
authors.forename: Antonio
authors.initials: A
authors.lastname: Stigliano
authors.affiliation: Endocrinologia, Ospedale Sant'Andrea, Dipartimento di Medicina Clinica e Molecolare, Facoltà di Medicina e Psicologia, Sapienza Università di Roma.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Toscano
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000628:therapy; D003480:Cushing Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007558:Italy; D007654:Ketoconazole / Q000627:therapeutic use; D008797:Metyrapone / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000150:complications* / Q000628:therapy; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D013004:Somatostatin; C517782:pasireotide; D007654:Ketoconazole; D006854:Hydrocortisone; D008797:Metyrapone