Treatment

The treatment of choice for Cushing's disease is selective transsphenoidal resection of the pituitary adenoma. The cure rate for this procedure is 70% to 80% for microadenomas at experienced centers. In some patients, total hypophysectomy is considered when the disease recurs after transsphenoidal resection. Many postsurgical patients require low-dose cortisol replacement for up to 12 months, until their endogenous adrenal function recovers.

Bilateral adrenalectomy with or without pituitary irradiation is offered to patients who have recurrence of hypercortisolemia or severe disease. For poor surgical candidates, adjunctive medical therapy is offered and includes metyrapone (blocker of 11p-hydroxylase), mitotane (O'P'DDD), and cyprohepta-dine. These treatment options have variable efficacy.

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