Medications for Cushing’s disease: a review.

From J D Faccinetti, chief editor and co-founder – We are pleased to announce a series of podcasts on the medical management of hypercortisolism. While the drugs reviewed can be used to treat all forms of hypercortisolism, including those due to ectopic ACTH hypersecretion and primary adrenal disorders, we focus on the use of these medications in patients with Cushing’s disease.

Medical therapy is often employed in patients who fail surgery or in those who are not candidates for surgery. It is occasionally used alone and at other times in combination with radiotherapy with the goal of discontinuing medical therapy when the radiotherapy takes effect. Sometimes, patients are treated with more than one medication. These drugs are used to control hypercortisolism and do not cure the disorder. In most cases, unless radiotherapy has been effective, or the tumor has died, discontinuation of these medications will result in recurrence of hypercortisolism and attendant symptoms and signs.

There are six podcasts covering the medications used to treat Cushing’s disease. The first three will focus on adrenal biosynthesis inhibitors including ketoconazole, metyrapone, and osilodrostat (Isturisa). Thereafter, we will review the somatostatin receptor ligand pasireotide (Signafor). We will conclude the series with a review of the glucocorticoid receptor modulation by mifepristone (Korlym) and the recently approved drug Levoketoconazole.  In each of these podcasts, Dr. Blevins reviews the mechanisms of action of these drugs, the results of seminal research studies demonstrating efficacy and side effects, and will also share his insights gleaned from employing these drugs to manage patients with hypercortisolism.

We did not review mitotane, a drug that has been used in Cushing’s disease but is mostly used in adrenal cancer. In fact, Dr. Blevins stopped using this medication in patients with Cushing’s disease in the 1990s due to the preponderance of side effects encountered by treated patients.  Also, we didn’t review dopamine agonist drugs, including bromocriptine and cabergoline as these drugs have limited efficacy, the benefit is often lost over time and there are better alternatives available today.

This is an informative overview regarding these medications with a few interesting patient vignettes for illustrative purposes.  Click here to listen to the podcasts.

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