Treatment and Management

Understand The 3 Goals Of Treatment

The goals of treating hypercortisolism are to1:

Target the
underlying cause

Improve signs and
symptoms

Enhance quality
of life

In General, Surgery Is The Recommended First-line Treatment For Eligible People2,3

Adrenalectomy

Involves complete or partial removal of the adrenal glands, which often results in immediate resolution of hypercortisolism and may involve lifelong hormone replacement therapy.4 However:

  • In a long-term follow-up study, a majority of people (75%, 118/157) did not undergo clinically indicated adrenalectomy surgery due to evidence of bilateral secretion, personal preference, or refusal of surgical treatment5

Transsphenoidal surgery

Directs an endoscope and/or surgical instruments through the nose to the bottom of the skull where the pituitary gland is located.4

  • In a large multicenter study, 96% (220/230) of people with pituitary adenomas were treated with surgery—however, only 41% achieved biochemical control of excess cortisol6

When To Consider Medical Therapy

Medical therapy should be considered in people who are not candidates for surgery or have failed surgery. It can treat the underlying cause of hypercortisolism, help address the symptoms such as hyperglycemia and hypertension, and help reduce cardiovascular risk.2

It is important to find the right medical therapy to meet individual patient needs2,7—there are several therapies with varying mechanisms of action to manage the impact of elevated cortisol.

Modulate cortisol activity by competing with cortisol at the glucocorticoid receptor2

Inhibit key enzymes needed to produce cortisol2

Target key cells in pituitary adenomas to inhibit adrenocorticotropic hormone secretion2

  • Medical therapy for hypercortisolism is not intended to replace medications that manage comorbidities1

  • Dose adjustments to medications and continued monitoring may be required2

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References

1. Nieman LK, Biller BM, Findling JW, et al. J Clin Endocrinol Metab. 2015;100(8):2807-2831. doi:10.1210/jc.2015-1818 2. Fleseriu M, Auchus R, Bancos I, et al. Lancet Diabetes Endocrinol. 2021;9(12):847-875. doi:10.1016/S2213-8587(21)00235-7 3. Zeiger MA, Thompson GB, Duh QY, et al. Endocr Prac. 2009;15(suppl 1):1-20. doi:10.4158/EP.15.S1.1 4. Tritos NA, Biller BM, Swearingen B. Nat Rev Endocrinol. 2011;7(5):279-289. doi:10.1038/nrendo.2011.12 5. Petramala L, Olmati F, Concistrè A, et al. Endocrine. 2020;70(1):150-163. doi:10.1007/s12020-020-02297-2 6. Geer EB, Shafiq I, Gordon MB, et al. Endocr Pract. 2017;23(8):962-970. doi:10.4158/EP171787.OR 7. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121