Treatment of endogenous Cushing’s syndrome depends on the etiology. Surgery remains the mainstay of treatment. Other second-line therapies include medical and radiotherapy.
Surgery is directed towards resection of the tumour- transsphenoidal surgery (TSS) of cortico-tropinoma in case of Cushing’s disease, excision of primary tumour in case of ectopic ACTH/ CRH syndrome and removal of adrenal mass in adrenal adenoma. Unilateral or bilateral adrenalectomy is done in case of malignancy, PPNAD, AIMAH or in case the primary lesion cannot be identified or resected.
Radiotherapy (RT) is an adjuvant therapy for Cushing’s disease in those who have failed TSS. It can be employed either as conventional RT or stereotactic radiosurgery. The response is earlier and better in children compared to adults.
Medical treatment is used in those with unresectable tumour, recurrent tumour, those who have contra-indications for surgery, those with non-localized sources of Cushing’s syndrome, those with mild disease, etc. Drugs acting at different targets are used and they include those that inhibit steroidogenesis like Metyrapone, Ketoconazole, Mitotane and Etomidate; glucocorticoid receptor antagonists like Mifepristone; and agents that modulate ACTH release like Pasireotide, and Bromocriptine, Cabergoline.
Author(s) Details:
Santosh B
Department of Endocrinology, Yashoda Hospital, Secunderabad, Telangana, India.
Raman Boddula
Department of Endocrinology, Yashoda Hospital, Secunderabad, Telangana, India.
Ashok Venkatanarasu
Department of Endocrinology, Yashoda Hospital, Secunderabad, Telangana, India.
Aditya Hegde
Department of Endocrinology, Yashoda Hospital, Secunderabad, Telangana, India.
Chimutai Chinte
Department of Endocrinology, Yashoda Hospital, Secunderabad, Telangana, India.
Vidya Tickoo
Department of Endocrinology, Yashoda Hospital, Secunderabad, Telangana, India.
Recent Global Research Developments in Emerging Medical Therapies for Cushing’s Syndrome: A Review
Largest-ever analysis of Cushing’s Syndrome: A comprehensive study presented at ENDO 2021 found that endogenous Cushing’s syndrome is associated with a threefold increase in mortality, primarily due to cardiovascular disease and infections. The study analyzed data from over 19,000 patients and highlighted the importance of advances in diagnosis and treatment [1] .
New pharmacological data on HSD-1 inhibitors: Research presented at ENDO 2022 focused on the human body’s response to potent HSD-1 inhibition by SPI-62. This study emphasized that urinary free cortisol levels do not always correlate with clinical symptoms, suggesting the need for better biomarkers [2] .
Current and emerging medical treatments: A review article discusses the efficacy and safety of current and near-future medical options for treating Cushing’s syndrome. It covers updates on clinical trials and novel drugs in development [3] .
Update on medical treatment for Cushing’s disease: This review summarizes all currently available medical therapies and discusses novel treatments in phase 3 clinical trials, such as osilodrostat and levoketoconazole, focusing on their indications, efficacy, and safety [4] .
Advances in clinical trials: Another review highlights the progress in clinical trials for new treatments targeting Cushing’s syndrome, including the development of drugs that modulate cortisol levels more effectively [5] .
References
- Largest-ever analysis of its kind finds Cushing’s syndrome triples risk of death
https://www.endocrine.org/news-and-advocacy/news-room/featured-science-from-endo-2021/largest-ever-analysis-of-its-kind-finds-cushings-syndrome-triples-risk-of-death - New Cushing’s Syndrome Research Presented at ENDO 2022
https://endocrinenews.endocrine.org/new-cushings-syndrome-research-presented-at-endo-2022/ - Hinojosa-Amaya, J. M., Cuevas-Ramos, D., & Fleseriu, M. (2019). Medical management of Cushing’s syndrome: current and emerging treatments. Drugs, 79, 935-956.
- Hinojosa-Amaya, J.M., Cuevas-Ramos, D. & Fleseriu, M. Medical Management of Cushing’s Syndrome: Current and Emerging Treatments. Drugs 79, 935–956 (2019). https://doi.org/10.1007/s40265-019-01128-7
