Therapeutic options after surgical failure in Cushing's disease: A critical review. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Rubinstein, German; Osswald, Andrea; Zopp, Stephanie; Ritzel, Katrin; Theodoropoulou, Marily; Beuschlein, Felix; Reincke, Martin
• Is Part Of: Best practice & research. Volume 33:Issue 2(2019)
• Publication Date: 2019-04
• Subjects: hypercortisolism -- ACTH -- transsphenoidal surgery -- adrenal steroidogenesis inhibitor -- bilateral adrenalectomy -- pituitary radiation; Endocrine glands -- Diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; Endocrinology -- Periodicals; Metabolism -- Periodicals; 616.4
• DOI: 10.1016/j.beem.2019.04.004
• Languages: English
• ISSNs: 1521-690X

Abstract

Abstract : Cushing's disease (CD) is the most common etiology of Cushing's syndrome (CD) due to corticotroph pituitary adenoma, which are in most cases small (80–90% microadenomas) and in about 40% cannot be visualized on imaging of the sella. First-line treatment for CD is transsphenoidal surgery (TSS) with the aim of complete adenoma removal and preservation of pituitary gland function. As complete adenoma resection is not always possible, surgical failure is a common problem. This can be the case either due to persistent hypercortisolism after first TSS or recurrence of hypercortisolism after initially achieving remission. For these scenarios exist several therapeutic options with their inherent characteristics, which will be covered by this review.