Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

Abstract

Treatment of Cushing's syndrome is essential to reduce mortality and associated comorbidities. Effective treatment includes the normalization of cortisol levels or action. It also includes the normalization of comorbidities via directly treating the cause of Cushing's syndrome and by adjunctive treatments (eg, antihypertensives). Surgical resection of the causal lesion(s) is generally the first-line approach. The choice of second-line treatments, including medication, bilateral adrenalectomy, and radiation therapy (for corticotrope tumors), must be individualized to each patient.

Nebenniereninsuffizienz und Nebenniereninzidentalome

“…B. 100 mg Hydrocortison i. v. verabreicht wird [13,16,28,32,33] (Anmerkung: generell sind auch bei Hypophysenoperationen Glukokokortikoide intraoperativ in der Regel nicht zwingend notwendig, obwohl dies eine weit verbreitete Praxis ist). Am 1. postoperativen Tag sollte dann aber in der Früh unbedingt ein basaler Serum Cortisolwert (zur Evaluierung des operativen Erfolges bzw.…”

“…Hierbei wird ganz klar Hydrocortison (Hydrocortone ® ) empfohlen, wobei es, mangels klinischer Studien, keine klaren bzw. sehr heterogene Dosierungsempfehlungen dafür gibt [16,28] …”

Effective Medical Therapy for Cushing Disease Can Increase the Susceptibility to Relative Hypocortisolism

“…Transsphenoidal surgery (TSS) is the firstline therapy for most patients with CD, providing longterm remission rates of 44 to 90% (3). Relapse may occur in up to 46% of cases after long-term follow-up (5 to 10 years) (4), requiring second-line therapeutic intervention such as further surgery, radiotherapy, medical therapy, or bilateral adrenalectomy (5).…”

Análise da expressão da filamina A nos tumores hipofisários e suas implicações clínicas e terapêuticas

“…A taxa de recorrência após a cirurgia varia de 23% a 33%, sendo menor em microadenomas (122) . O tratamento farmacológico é utilizado quando a etiologia não foi definida, no preparo pré-operatório de pacientes com hipercortisolismo grave, ou, mais frequentemente, após falha do tratamento cirúrgico (122) .…”

“…O mecanismo de ação das principais drogas utilizadas é: bloqueio do receptor de glicocorticóide, inibição da esteroidogênese adrenal, como o cetoconazol, e ação direta no tumor hipofisário, como a CAB e o LRS de nova geração (122) .…”