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Overview of the treatment of Cushing's syndrome

INTRODUCTION

The hypercortisolemia in Cushing's syndrome is usually due to a corticotropin (ACTH)-producing pituitary tumor (Cushing's disease), ectopic ACTH secretion by a nonpituitary tumor, or cortisol secretion by an adrenal adenoma or carcinoma. There are also very rare tumors that secrete corticotropin-releasing hormone (CRH) ectopically, and occasional cases are caused by cortisol secretion by ACTH-independent macronodular or micronodular hyperplasia of the adrenal cortex.

Treatment should be directed, whenever possible, at the primary cause of the syndrome. It is therefore dependent upon accurate differential diagnosis [1]. (See "Establishing the cause of Cushing's syndrome".)

This topic provides an overview of the various therapeutic options available in the treatment of Cushing's syndrome. A detailed review of therapy for Cushing's disease and primary adrenal causes of hypercortisolism are presented separately (see appropriate topic reviews).

GENERAL PRINCIPLES

Ideal therapy of Cushing's syndrome would achieve the following goals [1,2]:

  • Reverse the clinical manifestations by reducing cortisol secretion to normal
  • Eradicate any tumor threatening the health of the patient
  • Avoid permanent dependence upon medications
  • Avoid permanent hormone deficiency
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