Surgical approach is still the optimal therapy for endogenous Cushing's syndrome. However, pharmacotherapy has a role as primary or adjunctive therapy, when surgery fails or the patient refuses or cannot be submitted to surgery. Steroidogenesis inhibitors are the main drugs used to control Cushing's syndrome by reducing cortisol levels by adrenolytic or direct blocking enzymatic actions. Ketoconazol is effective as monotherapy; methyrapone and mitotane are also effective as single on combined therapy. Neuromodulators (compounds that modulate ACTH release from a pituitary tumor) such as bromocriptine, cyproheptadine, and valproic acid have been tested in Cushing's disease with a poor response rate. Long-acting somatostatin analogs may decrease ACTH secretion in patients with ectopic ACTH producing tumors, with temporary control of Cushing's syndrome.
Hypercortisolism; Cushing's syndrome; Cushong's disease; Ectopic ACTH syndrome; steroidogenesis inhibitors; ACTH neuromodulators
