Second-line treatment for Cushing's disease when initial pituitary surgery is unsuccessful

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Adenectomy via transsphenoidal surgery is considered the treatment of choice for Cushing's disease. It is successful in about 80% of patients in the hands of an experienced surgeon. When transsphenoidal surgery fails or is contraindicated, a second-line treatment must be chosen. The review focuses on second-line treatment options. RECENT FINDINGS: Repeat pituitary surgery results in the cure of Cushing's disease in about 50% of cases. Bilateral adrenalectomy results in resolution of hypercortisolemia in almost all patients, but leaves the patient glucocorticoid and mineralocorticoid deficient. Nelson's syndrome, depending on the definition, occurs in up to 35% of these patients. Irradiation of the residual pituitary tumor typically takes several years before the full effect is realized; it can cause panhypopituitarism. Finally, pharmacologic treatment of persistent hypercortisolemia can be effective, but is often associated with untoward side effects. These side effects are a powerful deterrent to its use. Several new pharmacologic agents are being studied and show some promise. SUMMARY: Each of the second-line treatments for Cushing's disease currently available can be effective at treating hypercortisolism, but each has significant limitations. New pharmacologic agents may soon offer some very exciting treatment options.

Original languageEnglish (US)
Pages (from-to)323-328
Number of pages6
JournalCurrent Opinion in Endocrinology, Diabetes and Obesity
Volume14
Issue number4
DOIs
StatePublished - Aug 2007

Fingerprint

Pituitary ACTH Hypersecretion
Nelson Syndrome
Therapeutics
Mineralocorticoids
Cushing Syndrome
Adrenalectomy
Residual Neoplasm
Pituitary Neoplasms
Reoperation
Glucocorticoids

Keywords

  • Bilateral adrenalectomy
  • Cushing's disease
  • Radiotherapy
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Nutrition and Dietetics

Cite this

@article{c99c8ac743f14f1abafdf64ae629392d,
title = "Second-line treatment for Cushing's disease when initial pituitary surgery is unsuccessful",
abstract = "PURPOSE OF REVIEW: Adenectomy via transsphenoidal surgery is considered the treatment of choice for Cushing's disease. It is successful in about 80{\%} of patients in the hands of an experienced surgeon. When transsphenoidal surgery fails or is contraindicated, a second-line treatment must be chosen. The review focuses on second-line treatment options. RECENT FINDINGS: Repeat pituitary surgery results in the cure of Cushing's disease in about 50{\%} of cases. Bilateral adrenalectomy results in resolution of hypercortisolemia in almost all patients, but leaves the patient glucocorticoid and mineralocorticoid deficient. Nelson's syndrome, depending on the definition, occurs in up to 35{\%} of these patients. Irradiation of the residual pituitary tumor typically takes several years before the full effect is realized; it can cause panhypopituitarism. Finally, pharmacologic treatment of persistent hypercortisolemia can be effective, but is often associated with untoward side effects. These side effects are a powerful deterrent to its use. Several new pharmacologic agents are being studied and show some promise. SUMMARY: Each of the second-line treatments for Cushing's disease currently available can be effective at treating hypercortisolism, but each has significant limitations. New pharmacologic agents may soon offer some very exciting treatment options.",
keywords = "Bilateral adrenalectomy, Cushing's disease, Radiotherapy, Transsphenoidal surgery",
author = "Maria Fleseriu and Loriaux, {Donald (Lynn)} and Ludlam, {William H.}",
year = "2007",
month = "8",
doi = "10.1097/MED.0b013e328248b498",
language = "English (US)",
volume = "14",
pages = "323--328",
journal = "Current Opinion in Endocrinology, Diabetes and Obesity",
issn = "1752-296X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Second-line treatment for Cushing's disease when initial pituitary surgery is unsuccessful

AU - Fleseriu, Maria

AU - Loriaux, Donald (Lynn)

AU - Ludlam, William H.

PY - 2007/8

Y1 - 2007/8

N2 - PURPOSE OF REVIEW: Adenectomy via transsphenoidal surgery is considered the treatment of choice for Cushing's disease. It is successful in about 80% of patients in the hands of an experienced surgeon. When transsphenoidal surgery fails or is contraindicated, a second-line treatment must be chosen. The review focuses on second-line treatment options. RECENT FINDINGS: Repeat pituitary surgery results in the cure of Cushing's disease in about 50% of cases. Bilateral adrenalectomy results in resolution of hypercortisolemia in almost all patients, but leaves the patient glucocorticoid and mineralocorticoid deficient. Nelson's syndrome, depending on the definition, occurs in up to 35% of these patients. Irradiation of the residual pituitary tumor typically takes several years before the full effect is realized; it can cause panhypopituitarism. Finally, pharmacologic treatment of persistent hypercortisolemia can be effective, but is often associated with untoward side effects. These side effects are a powerful deterrent to its use. Several new pharmacologic agents are being studied and show some promise. SUMMARY: Each of the second-line treatments for Cushing's disease currently available can be effective at treating hypercortisolism, but each has significant limitations. New pharmacologic agents may soon offer some very exciting treatment options.

AB - PURPOSE OF REVIEW: Adenectomy via transsphenoidal surgery is considered the treatment of choice for Cushing's disease. It is successful in about 80% of patients in the hands of an experienced surgeon. When transsphenoidal surgery fails or is contraindicated, a second-line treatment must be chosen. The review focuses on second-line treatment options. RECENT FINDINGS: Repeat pituitary surgery results in the cure of Cushing's disease in about 50% of cases. Bilateral adrenalectomy results in resolution of hypercortisolemia in almost all patients, but leaves the patient glucocorticoid and mineralocorticoid deficient. Nelson's syndrome, depending on the definition, occurs in up to 35% of these patients. Irradiation of the residual pituitary tumor typically takes several years before the full effect is realized; it can cause panhypopituitarism. Finally, pharmacologic treatment of persistent hypercortisolemia can be effective, but is often associated with untoward side effects. These side effects are a powerful deterrent to its use. Several new pharmacologic agents are being studied and show some promise. SUMMARY: Each of the second-line treatments for Cushing's disease currently available can be effective at treating hypercortisolism, but each has significant limitations. New pharmacologic agents may soon offer some very exciting treatment options.

KW - Bilateral adrenalectomy

KW - Cushing's disease

KW - Radiotherapy

KW - Transsphenoidal surgery

UR - http://www.scopus.com/inward/record.url?scp=34447542175&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447542175&partnerID=8YFLogxK

U2 - 10.1097/MED.0b013e328248b498

DO - 10.1097/MED.0b013e328248b498

M3 - Article

C2 - 17940460

AN - SCOPUS:34447542175

VL - 14

SP - 323

EP - 328

JO - Current Opinion in Endocrinology, Diabetes and Obesity

JF - Current Opinion in Endocrinology, Diabetes and Obesity

SN - 1752-296X

IS - 4

ER -