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Medical combination therapies in Cushing’s disease

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Abstract

Introduction

There has been growing interest on medical therapy for the management of Cushing’s disease (CD), particularly in cases of persistent or recurrent hypercortisolism. Ketoconazole, an inhibitor of adrenal steroidogenesis, is the most widely used drug, whereas cabergoline and pasireotide are the most promising centrally acting agents. The main purpose of this review article is to highlight the options of medical treatment for CD, with a special emphasis on combination therapies, a topic that has only been addressed by a limited number of studies.

Conclusions

According to the results of these studies, combination therapies involving medications with additive or synergistic effects on ACTH and cortisol secretion seem quite attractive as they yield higher probability of longterm control of the hypercortisolism at lower doses, a lower incidence of side-effects, and possibly a lower rate of treatment escapes. Currently, ketoconazole, cabergoline, and pasireotide are the best drugs to be prescribed in combination.

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Conflict of interest

Marcello Bronstein is a principal investigator of the clinical trial CSOM230G2304 (Pasireotide LAR for Cushing´s disease). The other authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Rua Clovis Silveira Barros, 84/1202, Boa Vista, Recife, CEP 50.050-270, Brazil

    Lucio Vilar

  2. Division of Endocrinology, Brasilia University Hospital, Brasília, Brazil

    Luciana A. Naves

  3. Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil

    Márcio C. Machado & Marcello D. Bronstein

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  1. Lucio Vilar
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  2. Luciana A. Naves
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  3. Márcio C. Machado
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  4. Marcello D. Bronstein
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Correspondence to Lucio Vilar.

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Vilar, L., Naves, L.A., Machado, M.C. et al. Medical combination therapies in Cushing’s disease. Pituitary 18, 253–262 (2015). https://doi.org/10.1007/s11102-015-0641-x

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