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Mol Cell Endocrinol. 2015 Jun 15;408:185-9. doi: 10.1016/j.mce.2014.09.021. Epub 2014 Oct 29.

Current approaches to the pharmacological management of Cushing's disease.

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Martha Leland Sherwin Professor of Endocrinology, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address:


If treatment of Cushing's disease (CD) by surgery is not successful, medical therapy is often required. Long-term use of metyrapone is limited by hirsutism and hypertension and escape because of increased ACTH levels. Although ketoconazole can normalize cortisol levels in 50%, liver toxicity limits its use. Mitotane, an adrenolytic agent, has had minimal use for benign disease. Etomidate is useful when rapid reduction in cortisol levels is needed. Cabergoline can normalize cortisol levels in CD in about one-third of patients and is well tolerated. Pasireotide can normalize cortisol levels in CD in about 25% but causes worsening of glucose tolerance in most patients. Mifepristone, a blocker of cortisol receptors, improves clinical aspects of CD in most patients but cortisol and ACTH measurements do not reflect clinical activity and adrenal insufficiency, hypokalemia, and endometrial hyperplasia can occur. Combinations of drugs can be tried in patients resistant to monotherapy.


Adrenal; Cabergoline; Cushing's; Mifepristone; Pasireotide; Pituitary adenoma

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