Advances in medical treatment of Cushing's disease

It is well known that transphenoidal surgery is the first line of treatment for Cushing's disease (CD). In case of recurrence, pituitary irradiation or adrenalectomy are usually performed; however, the morbidity due to these procedures is not negligible. For this reason, there is still a strong need for medical therapy, although there are only a few controlled data on this field. A variety of compounds are invaluable complementary tools in the management of this serious condition for which no treatment has yet been proven fully satisfactory. Pharmacological treatment could be employed by using neuromodulatory drugs (i.e., serotonin antagonists, dopamine, and GABA agonists) active only in a few cases of hypothalamic-pituitary-dependent CD. New approaches at the pituitary tumor level involve the potential use of other compounds (e.g., PPAR-γ agonists and retinoic acid). Exciting news in treating CD includes the recent availability of new multiligand somatostatin analogues. This review focuses on the new potential pharmacologic approaches for the management of CD based on the recent identification of possible targets and/or pathogenetic mechanisms.