Cushing’s Disease: Medical Management

Transsphenoidal surgery, the optimal treatment for Cushing’s disease, achieves remission in 70–90% of patients. Subsequent treatment of patients who remain hypercortisolemic includes radiation therapy or adrenalectomy. However, there is a role for shortterm primary medical therapy and for adjunctive treatment while awaiting the effects of radiotherapy. The well-studied available agents inhibit cortisol production by the adrenal gland. It would be ideal to inhibit ACTH production or secretion from the tumor; however, such neuromodulatory agents are either ineffective or have not been studied extensively. This chapter will review existing agents, their mechanism of action, efficacy, and clinical application.