How to manage Cushing's disease after failed primary pituitary surgery

The first-line treatment for Cushing's disease is transsphenoidal adenomectomy, which can be curative in a significant number of patients. The second-line options in cases of failed primary pituitary surgery include repeat surgery, medical therapy, and radiation. The role for medical therapy ha...

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Bibliographic Details
Published in:European journal of endocrinology 2024-08, Vol.191 (3), p.R37-R54
Main Authors: Agrawal, Nidhi, Urwyler, Sandrine A, Mehta, Sonal, Karavitaki, Niki, Feelders, Richard A
Format: Article
Language:English
Subjects:
Adrenalectomy - methods
Humans
Pituitary ACTH Hypersecretion - surgery
Pituitary Gland - surgery
Pituitary Neoplasms - surgery
Reoperation
Treatment Failure
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Summary:The first-line treatment for Cushing's disease is transsphenoidal adenomectomy, which can be curative in a significant number of patients. The second-line options in cases of failed primary pituitary surgery include repeat surgery, medical therapy, and radiation. The role for medical therapy has expanded in the last decade, and options include pituitary-targeting drugs, steroid synthesis inhibitors, and glucocorticoid receptor antagonists. Bilateral adrenalectomy is a more aggressive approach, which may be necessary in cases of persistent hypercortisolism despite surgery, medical treatment, or radiation or when rapid normalization of cortisol is needed. We review the available treatment options for Cushing's disease, focusing on the second-line treatment options to consider after failed primary pituitary surgery.
ISSN:0804-4643
1479-683X
1479-683X
DOI:10.1093/ejendo/lvae110