Cushing's syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

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.

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]

• 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.^[3]

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.

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