Approach to the Patient Treated with Steroidogenesis Inhibitors

Abstract Steroidogenesis inhibitors can be given to control the hypercortisolism of Cushing’s syndrome in various situations: when surgery has been unsuccessful or not possible; in metastatic adrenocorticotropin hormone (ACTH) or cortisol-secreting tumors; when waiting for the maximal efficacy of ra...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2021-07, Vol.106 (7), p.2114-2123
Main Authors: Castinetti, Frederic, Nieman, Lynnette K, Reincke, Martin, Newell-Price, John
Format: Article
Language:English
Subjects:
ACTH
Adrenocorticotropic hormone
Adrenocorticotropic Hormone - drug effects
Adult
Approaches to the Patient
Biomarkers
Comorbidity
Corticosteroids
Cushing Syndrome - drug therapy
Drug therapy
Enzyme Inhibitors - therapeutic use
Female
Human health and pathology
Humans
Imidazoles - therapeutic use
Intermedin
Ketoconazole
Ketoconazole - therapeutic use
Life Sciences
Metastases
Methods
Metyrapone - therapeutic use
Nervous system diseases
Patients
Pharmaceutical industry
Pituitary
Pyridines - therapeutic use
Side effects
Steroidogenesis
Titration
Tumors
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Summary:Abstract Steroidogenesis inhibitors can be given to control the hypercortisolism of Cushing’s syndrome in various situations: when surgery has been unsuccessful or not possible; in metastatic adrenocorticotropin hormone (ACTH) or cortisol-secreting tumors; when waiting for the maximal efficacy of radiation techniques; for rapid treatment of severe hypercortisolism in patients with occult ACTH-producing tumors; or as a presurgical treatment in patients with severe comorbidities. Whilst biochemical “control” can be achieved in more than 50% of cases, daily management of such drugs can be challenging. Indeed, with a “dose-titration” or a “block and replace” approach, defining eucortisolism is usually difficult, requiring the measurement of several biological markers. Moreover, each drug has its own side effects, which must be monitored closely. The aim of this “approach to the patient” is to shed light on the management of hypercortisolism with 4 steroidogenesis inhibitors (ketoconazole, levoketoconazole, metyrapone, osilodrostat) to help endocrinologists dealing with patients with Cushing’s syndrome. Various points will be discussed, such as initial dose of treatment, dose schedule, monitoring of efficacy, and side effects of monotherapy. The combination of steroidogenesis inhibitors will also be discussed.
ISSN:0021-972X
1945-7197
DOI:10.1210/clinem/dgab122