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TREATMENT OF CUSHING'S SYNDROME : WHAT PLACE FOR MEDICAL TREATMENT?

O Chabre1, J Cristante1

  • 1Grenoble Alpes University Hospital (CHUGA) - Endocrinology, Grenoble, France.

Acta Endocrinologica (Bucharest, Romania : 2005)
|September 12, 2019
PubMed
Summary
This summary is machine-generated.

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Medical treatments for Cushing's syndrome (CS) are being reassessed due to new drug developments. While surgery is primary, medical options are now considered for specific situations like pre-operative management or treatment failure.

Area of Science:

  • Endocrinology
  • Surgical Oncology

Background:

  • Cushing's syndrome (CS) is primarily treated with surgery.
  • Bilateral adrenalectomy (BA) is a highly effective second-line surgical option.
  • Limited scope for medical treatment (MT) in CS has historically been assumed.

Purpose of the Study:

  • To reassess the role of medical treatment (MT) in Cushing's syndrome (CS).
  • To analyze the efficacy and tolerance of both surgical and medical treatments for CS.
  • To differentiate between consensual and controversial indications for MT in CS.

Main Methods:

  • Review of existing literature on surgical and medical treatments for CS.
  • Analysis of drug development targeting ACTH secretion or cortisol synthesis.
  • Comparative evaluation of efficacy and side effects of different treatment modalities.
Keywords:
Cushing’spituitary surgery

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Main Results:

  • Consensual indications for MT include pre-operative management, inoperability, and management of surgical failure or recurrence (especially in Cushing's disease post-transsphenoidal surgery).
  • Controversial indications for MT include the unavailability of expert surgeons, which is questioned given MT costs.
  • Balancing MT efficacy and side effects against BA is crucial for recurrent or failed surgical cases.

Conclusions:

  • Medical treatments for Cushing's syndrome warrant reassessment due to recent therapeutic advancements.
  • Specific indications for medical management are now recognized, particularly in complex or treatment-resistant cases.
  • Careful consideration of risks and benefits is essential when choosing between medical therapy and bilateral adrenalectomy.