Skip to main content

Management of Cushing’s Disease

  • Chapter
  • First Online:
Pituitary Tumors

Abstract

Transsphenoidal pituitary surgery is the mainstay of therapy in Cushing’s disease. Patients with recurrent or persistent Cushing’s disease may have several treatment options, including a second pituitary operation, radiation therapy with interim medical therapy, or bilateral adrenalectomy. Prompt treatment of hypercortisolism is advisable before and during pregnancy in order to optimize maternal and fetal outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Nieman LK, Biller BM, Findling JW, Murad MH, Newell-Price J, Savage MO, Tabarin A. Treatment of Cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metabol. 2015;100(8):2807–31.

    Article  CAS  Google Scholar 

  2. Swearingen B, Biller BM, Barker FG, Katznelson L, Grinspoon S, Klibanski A, Zervas NT. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med. 1999;130(10):821–4.

    Article  CAS  PubMed  Google Scholar 

  3. Barker FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metabol. 2003;88(10):4709–19.

    Article  CAS  Google Scholar 

  4. Tritos NA, Biller BM, Swearingen B. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279–89.

    Article  CAS  PubMed  Google Scholar 

  5. Esposito F, Dusick JR, Cohan P, Moftakhar P, McArthur D, Wang C, Swerdloff RS, Kelly DF. Early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metabol. 2006;91(1):7–13.

    Article  CAS  Google Scholar 

  6. Ram Z, Nieman LK, Cutler GB Jr, Chrousos GP, Doppman JL, Oldfield EH. Early repeat surgery for persistent Cushing’s disease. J Neurosurg. 1994;80(1):37–45.

    Article  CAS  PubMed  Google Scholar 

  7. Minniti G, Osti M, Jaffrain-Rea ML, Esposito V, Cantore G, Enrici RM. Long-term follow-up results of postoperative radiation therapy for Cushing’s disease. J Neurooncol. 2007;84(1):79–84.

    Article  PubMed  Google Scholar 

  8. Petit JH, Biller BM, Yock TI, Swearingen B, Coen JJ, Chapman P, Ancukiewicz M, Bussiere M, Klibanski A, Loeffler JS. Proton stereotactic radiotherapy for persistent adrenocorticotropin-producing adenomas. J Clin Endocrinol Metabol. 2008;93(2):393–9.

    Article  CAS  Google Scholar 

  9. Feigl GC, Bonelli CM, Berghold A, Mokry M. Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg. 2002;97:415–21.

    PubMed  Google Scholar 

  10. Sonino N, Boscaro M, Paoletta A, Mantero F, Zillotto D. Ketoconazole treatment in Cushing’s syndrome: experience in 34 patients. Clin Endocrinol (Oxf). 1991;35(4):347–52.

    Article  CAS  Google Scholar 

  11. Berwaerts J, Verhelst J, Mahler C, Abs R. Cushing’s syndrome in pregnancy treated by ketoconazole: case report and review of the literature. Gynecol Endocrinol. 1999;13(3):175–82.

    Article  CAS  PubMed  Google Scholar 

  12. Amado JA, Pesquera C, Gonzalez EM, Otero M, Freijanes J, Alvarez A. Successful treatment with ketoconazole of Cushing’s syndrome in pregnancy. Postgrad Med J. 1990;66(773):221–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Prebtani AP, Donat D, Ezzat S. Worrisome striae. Lancet. 2000;355(9216):1692.

    Article  CAS  PubMed  Google Scholar 

  14. Verhelst JA, Trainer PJ, Howlett TA, Perry L, Rees LH, Grossman AB, Wass JA, Sesser GM. Short and long-term responses to metyrapone in the medical management of 91 patients with Cushing’s syndrome. Clin Endocrinol (Oxf). 1991;35(2):169–78.

    Article  CAS  Google Scholar 

  15. Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK. Cushing’s syndrome during pregnancy: personal experience and review of the literature. J Clin Endocrinol Metabol. 2005;90(5):3077–83.

    Article  CAS  Google Scholar 

  16. Luton JP, Mahoudeau JA, Bouchard PH, Thieblot PH, Hautecouverture M, Simon D, Laudat MH, Touitou Y, Bricaire H. Treatment of Cushing’s disease by o,p′ DDD: survey of 62 cases. N Engl J Med. 1979;300(9):459–64.

    Article  CAS  PubMed  Google Scholar 

  17. Leiba S, Weinstein R, Shindel B, Lapidot M, Stern E, Levavi H, Rusecki Y, Abramovici A. The protracted effect of o,p′-DDD in Cushing’s disease and its impact on adrenal morphogenesis of young human embryo. Ann Endocrinol. 1989;50(1):49–53.

    CAS  Google Scholar 

  18. Schulte HM, Benker G, Reinwein D, Sippell WG, Allolio B. Infusion of low dose etomidate: correction of hypercortisolemia in patients with Cushing’s syndrome and dose-response relationship in normal subjects. J Clin Endocrinol Metabol. 1990;70(5):1426–30.

    Article  CAS  Google Scholar 

  19. Godbout A, Manavela M, Danilowicz K, Beauregard H, Bruno OD, Lacroix A. Cabergoline monotherapy in the long-term treatment of Cushing’s disease. Eur J Endocrinol. 2010;163(5):709–16.

    Article  CAS  PubMed  Google Scholar 

  20. Petersenn S, Salgado LR, Schopohl J, Portocarrero-Ortiz L, Arnaldi G, Lacroix A, Scaroni C, Ravichandran S, Kandra A, Biller BM. Long-term treatment of Cushing’s disease with pasireotide: 5-year results from an open-label extension study of a Phase III trial. Endocrine. 2017;57(1):156–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Castinetti F, Fassnacht M, Johanssen S, Terzolo M, Bouchard P, Chanson P, Do Cao C, Morange I, Pico A, Ouzounian S, Young J. Merits and pitfalls of mifepristone in Cushing’s syndrome. Eur J Endocrinol. 2009;160(6):1003–10.

    Article  CAS  PubMed  Google Scholar 

  22. Vik-Mo EO, Øksnes M, Pedersen PH, Wentzel-Larsen T, Rødahl E, Thorsen F, Schreiner T, Aanderud S, Lund-Johansen M. Gamma knife stereotactic radiosurgery of Nelson syndrome. Eur J Endocrinol. 2009;160(2):143–8.

    Article  CAS  PubMed  Google Scholar 

  23. Thompson SK, Hayman AV, Ludlam WH, Deveney CW, Loriaux DL, Sheppard BC. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg. 2007;245(5):790.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lindsay JR, Nieman LK. The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocr Rev. 2005;26(6):775–99.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicholas A. Tritos .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jahandideh, D., Tritos, N.A. (2018). Management of Cushing’s Disease. In: Nachtigall, L. (eds) Pituitary Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-90909-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90909-7_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90907-3

  • Online ISBN: 978-3-319-90909-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics