Medical management of Cushing's syndrome

Cushing's syndrome is a debilitating endocrine disorder which results from hypercortisolemia. While endogenous Cushing's syndrome can be caused by an adrenocorticotrophic hormone (ACTH)-dependent or ACTH-independent mechanism, it is most often a result of excess secretion of ACTH by a corticotroph adenoma (Cushing's disease). Untreated hypercortisolemia causes significant morbidity and increased mortality due to its metabolic effects including hypertension, osteoporosis, obesity, dyslipidemia, osteoporosis and glucose intolerance. Although primary therapy is surgical, a substantial portion of patients will go on to require second-line therapies including repeat surgery, radiotherapy or drug therapy. While medical therapy for Cushing's syndrome has been limited, several new agents are being investigated. This aim of this review is to analyze and present the available options for medical management of Cushing's syndrome as well as review potential new therapies and their role in the treatment of this disorder.