Medical therapy of Cushing's disease.

摘要: Surgical excision of an ACTH-producing pituitary tumor is the optimal therapy for Cushing's disease. However, medical may have either a primary or adjunctive role if patient cannot safely undergo surgery, surgery fails, recurs. When medication only therapy, major disadvantage need lifelong therapy; in general, recurrence follows discontinuation treatment. These compounds work through three broad mechanisms action. "Neuromodulatory" modulate corticotropin (ACTH) release from tumor, steroidogenesis inhibitors reduce cortisol levels by adrenolytic activity and/or direct enzymatic inhibition and glucocorticoid antagonists block action at its receptor. In neuromodulatory (bromocriptine, cyproheptidine, somatostatin valproic acid) are not very effective agents Treatment with antagonist radiation has been reported on single only. Steroidogenesis inhibitors, including mitotane, metyrapone, ketoconazole, aminoglutethimide, choice ketoconazole best tolerated these as monotherapy about 70% patients. Mitotane metyrapone be agents, while aminoglutethimide generally must given combination. The intravenously-administered etomidate used when patients take medications mouth.