Effectiveness of medical treatment for Cushing’s syndrome: a systematic review and meta-analysis

Abstract

PurposeTo systematically review the effectiveness of medical treatment for Cushing’s syndrome in clinical practice, regarding cortisol secretion, clinical symptom improvement, and quality of life. To assess the occurrence of side effects of these medical therapies.MethodsEight electronic databases were searched in March 2017 to identify potentially relevant articles. Randomized controlled trials and cohort studies assessing the effectiveness of medical treatment in patients with Cushing’s syndrome, were eligible. Pooled proportions were reported including 95% confidence intervals.ResultsWe included 35 articles with in total 1520 patients in this meta-analysis. Most included patients had Cushing’s disease. Pooled reported percentage of patients with normalization of cortisol ranged from 35.7% for cabergoline to 81.8% for mitotane in Cushing’s disease. Patients using medication monotherapy showed a lower percentage of cortisol normalization compared to use of multiple medical agents (49.4 vs. 65.7%); this was even higher for patients with concurrent or previous radiotherapy (83.6%). Mild side effects were reported in 39.9%, and severe side effects were seen in 15.2% of patients after medical treatment. No meta-analyses were performed for clinical symptom improvement or quality of life due to lack of sufficient data.ConclusionsThis meta-analysis shows that medication induces cortisol normalization effectively in a large percentage of patients. Medical treatment for Cushing’s disease patients is thus a reasonable option in case of a contraindication for surgery, a recurrence, or in patients choosing not to have surgery. When experiencing side effects or no treatment effect, an alternate medical therapy or combination therapy can be considered.Electronic supplementary materialThe online version of this article (10.1007/s11102-018-0897-z) contains supplementary material, which is available to authorized users.

Role of Hypothalamic-Pituitary-Adrenal Axis, Hypothalamic-Pituitary-Gonadal Axis and Insulin Signaling in the Pathophysiology of Alzheimer’s Disease

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Local hyperthermia cleared multifarious viral warts in a patient with Cushing's syndrome

“…Here, we report a case recently treated for recalcitrant and multifarious warts associated with Cushing's syndrome. Cushing's syndrome involves a collection of signs and symptoms including high blood pressure, abdominal obesity, and weak bones due to prolonged exposure to cortisol (Broersen, Jha, Biermasz, Pereira, & Dekkers, 2018;Nieman & Ilias, 2005;Pivonello et al, 2016). The impairment of immune function associated with active Cushing's syndrome is responsible for the susceptibility to infections in these patients (Fareau & Vassilopoulou-Sellin, 2007;Pivonello, De Martino, De Leo, et al, 2007).…”

Current management of Cushing's disease

“…There are currently three groups of medications used in patients with CD (Table ), which are conveniently categorized depending on their site of action, including steroidogenesis inhibitors (inhibiting adrenal steroidogenesis), centrally acting agents (controlling excessive ACTH secretion) and glucocorticoid receptor (GR) antagonists (inhibiting cortisol action) .…”