Cushing's syndrome medical therapy: Difference between revisions
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{{Cushing's syndrome}} | {{Cushing's syndrome}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{MMF}} | ||
==Overview== | ==Overview== | ||
The medications usually used for the treatment of Cushing's syndrome are [[Pasireotide]], [[Cabergoline]], [[Ketoconazole]] and [[Metyrapone]]. The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost. | |||
==Medical therapy== | ==Medical therapy== | ||
The medications usually used for the treatment of Cushing's syndrome are: | Indications for [[medical treatment]] of Cushing's syndrome include:<ref name="pmid22936543">{{cite journal |vauthors=van der Pas R, de Herder WW, Hofland LJ, Feelders RA |title=New developments in the medical treatment of Cushing's syndrome |journal=Endocr. Relat. Cancer |volume=19 |issue=6 |pages=R205–23 |year=2012 |pmid=22936543 |doi=10.1530/ERC-12-0191 |url=}}</ref> | ||
*Pasireotide | *Acute [[complications]] of [[hypercortisolism]] ([[psychosis]], and [[infection]]). | ||
*Cabergoline | *Surgery pretreatment in severe cases if [[surgery]] is delayed. | ||
*Ketoconazole | *[[Hypercortisolism]] after unsuccessful surgery, while awaiting control from [[radiotherapy]]. | ||
*Metyrapone | *Unresectable or [[Metastatic tumor|metastatic tumors]]. | ||
*Mitotane | *[[Hypercortisolism]] due to an occult [[Ectopic ACTH Syndrome|ectopic ACTH-producing]] [[Neuroendocrine tumors|neuroendocrine tumor]]. | ||
*Mifepristone | The [[medications]] usually used for the treatment of Cushing's syndrome are:<ref name="pmid26004339">{{cite journal |vauthors=Lacroix A, Feelders RA, Stratakis CA, Nieman LK |title=Cushing's syndrome |journal=Lancet |volume=386 |issue=9996 |pages=913–27 |year=2015 |pmid=26004339 |doi=10.1016/S0140-6736(14)61375-1 |url=}}</ref> | ||
*[[Pasireotide]] | |||
*[[Cabergoline]] | |||
*[[Ketoconazole]] | |||
*[[Metyrapone]] | |||
*[[Mitotane]] | |||
*[[Mifepristone]] | |||
The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost.<ref name="urlTreatment of Cushings Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://doi.org/10.1210/jc.2015-1818 |title=Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |format= |work= |accessdate=}}</ref> | |||
===Drug regimen=== | ===Drug regimen=== | ||
Drug regimens used for the treatment of Cushing's syndrome are: <ref name="pmid26004339">{{cite journal |vauthors=Lacroix A, Feelders RA, Stratakis CA, Nieman LK |title=Cushing's syndrome |journal=Lancet |volume=386 |issue=9996 |pages=913–27 |year=2015 |pmid=26004339 |doi=10.1016/S0140-6736(14)61375-1 |url=}}</ref> | |||
* | *Drug regimen 1: [[Ketoconazole]] 400–1600 mg per day orally | ||
* | *Drug regimen 2: [[Mifepristone]] 300–1200 mg per day orally | ||
*Metyrapone 0·5–4·5 g per day orally | *Drug regimen 3: [[Metyrapone]] 0·5–4·5 g per day orally | ||
* | *Drug regimen 4: [[Pasireotide]] 750–2400 μg per day subcutaneously injected | ||
* | *Drug regimen 5: [[Cabergoline]] Up to 7 mg per week orally | ||
*Drug regimen 6: [[Mitotane]] 3–5 g per day orally | |||
It is important to remember that the vast majority of cases of Cushing's syndrome are caused by [[steroid]] medications (such causes are described as [[iatrogenic]]) so a review of medications first, as stopping or reducing the dose can usually resolve the problem. | |||
==References== | ==References== | ||
Latest revision as of 00:15, 30 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Overview
The medications usually used for the treatment of Cushing's syndrome are Pasireotide, Cabergoline, Ketoconazole and Metyrapone. The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost.
Medical therapy
Indications for medical treatment of Cushing's syndrome include:[1]
- Acute complications of hypercortisolism (psychosis, and infection).
- Surgery pretreatment in severe cases if surgery is delayed.
- Hypercortisolism after unsuccessful surgery, while awaiting control from radiotherapy.
- Unresectable or metastatic tumors.
- Hypercortisolism due to an occult ectopic ACTH-producing neuroendocrine tumor.
The medications usually used for the treatment of Cushing's syndrome are:[2]
The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost.[3]
Drug regimen
Drug regimens used for the treatment of Cushing's syndrome are: [2]
- Drug regimen 1: Ketoconazole 400–1600 mg per day orally
- Drug regimen 2: Mifepristone 300–1200 mg per day orally
- Drug regimen 3: Metyrapone 0·5–4·5 g per day orally
- Drug regimen 4: Pasireotide 750–2400 μg per day subcutaneously injected
- Drug regimen 5: Cabergoline Up to 7 mg per week orally
- Drug regimen 6: Mitotane 3–5 g per day orally
It is important to remember that the vast majority of cases of Cushing's syndrome are caused by steroid medications (such causes are described as iatrogenic) so a review of medications first, as stopping or reducing the dose can usually resolve the problem.
References
- ↑ van der Pas R, de Herder WW, Hofland LJ, Feelders RA (2012). "New developments in the medical treatment of Cushing's syndrome". Endocr. Relat. Cancer. 19 (6): R205–23. doi:10.1530/ERC-12-0191. PMID 22936543.
- ↑ 2.0 2.1 Lacroix A, Feelders RA, Stratakis CA, Nieman LK (2015). "Cushing's syndrome". Lancet. 386 (9996): 913–27. doi:10.1016/S0140-6736(14)61375-1. PMID 26004339.
- ↑ "Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".