Cited by 21Pituitary Gland Disorders and TreatmentsAdrenal and Paraganglionic TumorsAdrenal Hormones and Disorders

What is the role of medical therapy in adrenal-dependent Cushing’s syndrome?

Braun, Leah T., Reincke, Martin·2020·Best Practice & Research Clinical Endocrinology & Metabolism

Abstract

Medical therapy to control hypercortisolism in adrenal Cushing's syndrome is currently not the first-line therapy. However, in many clinical scenarios like pre-surgical treatment, in patients who are not suitable candidates for surgery or in patients with bilateral hyperplasia, medical therapy can be important representing the only viable treatment option. Adrenal steroidogenesis inhibitors and glucocorticoid receptor blockers have been used for many years: metyrapone, ketoconazole and mifepristone are in current use and effective. Mitotane can be used as well but is considered second-line therapy because of its high toxicity. Etomidate has a special position as emergency medication in severe hypercortisolism. New drugs are tested in prospective trials (levoketoconazole, osilidrostat and relacorilant) and might become effective alternatives to common drugs. Oher drugs - adrenal steroidogenesis inhibitors as well as glucocorticoid receptor antagonists - are currently tested in vitro.

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Crossref · 10.1016/j.beem.2020.101376

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Authors
Braun, L. T., & Reincke, M.
Affiliations
LMU Klinikum (DE)
Corresponding author
Braun, Leah T.
Venue
Best Practice & Research Clinical Endocrinology & Metabolism
Publisher
Elsevier BV
Published
2020-05
Volume
34
Issue
3
Pages
101376
ISSN
1521-690X (ISSN-L)
OpenAlex
W3003170113
Cited by
21
References
74
Citations by year
2026: 2 · 2025: 6 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 2
FWCI
0.42
Type
journal article
Language
en
Open access
closed
Locations
  • Best Practice & Research Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
adrenal Cushing's syndrome, hypercortisolism, medical therapy, metyrapone, ketoconazole, mifepristone, mitotane, etomidate, relacorilant, glucocorticoid receptor antagonist, steroidogenesis inhibitors, bilateral adrenal hyperplasia, drug toxicity
MeSH terms
Adrenal Gland Diseases, Cushing Syndrome, Humans, Ketoconazole, Metyrapone, Mitotane, Prospective Studies, Treatment Outcome, Pituitary ACTH Hypersecretion

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