Management of patients with persistent or recurrent Cushing’s disease after initial pituitary surgery

Cristina Capatina, José Miguel Hinojosa-Amaya, Catalina Poiana, Maria Fleseriu

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Introduction: Treatment options for persistent and recurrent Cushing’s disease (CD) include an individualized approach for repeat surgery, medical treatment, radiation therapy (RT), and bilateral adrenalectomy (BLA). Areas covered: In this expert opinion perspective, the authors review the latest treatment(s) for persistent/recurrent CD. A PubMed search was undertaken (English articles through May 2020) and relevant articles discussed. Repeat pituitary surgery should be considered in most patients with proven hypercortisolism; there is potential for cure with low risk of major complications. Medical therapy is valuable either alone, while awaiting the effects of RT, or in preparation for BLA. Medical therapy includes steroidogenesis inhibitors, agents that act at the pituitary or glucocorticoid receptor level, and novel agents in development. Radiation therapy has been used successfully to treat CD, but hypopituitarism risk and delayed efficacy (improved with radiosurgery) are major drawbacks. Laparoscopic BLA is safe and effective in patients with severe, difficult-to-manage hypercortisolism, but long-term follow-up is required as corticotroph tumor progression can develop. Expert opinion: Treatment of persistent/recurrent CD is challenging. Most patients require >1 therapy to achieve long-lasting remission. There is currently no ideal single treatment option that provides high and rapid efficacy, low adverse effects, and preserves normal pituitary-adrenal axis function.

Original languageEnglish (US)
Pages (from-to)321-339
Number of pages19
JournalExpert Review of Endocrinology and Metabolism
Volume15
Issue number5
DOIs
StatePublished - Sep 2 2020

Keywords

  • Cushing’s disease
  • adrenalectomy
  • medical therapy
  • persistence
  • radiotherapy
  • recurrence
  • repeat surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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