Treatment and Management

SURGERY IS THE RECOMMENDED FIRST-LINE TREATMENT FOR HYPERCORTISOLISM1,2

Transsphenoidal surgery is a surgical option that directs an endoscope and/or surgical instruments through the nose to the bottom of the skull where the pituitary gland is located.3

Adrenalectomy is a different surgical option that involves complete or partial removal of the adrenal glands. This treatment often results in immediate resolution of hypercortisolism and may involve lifelong hormone replacement therapy.3

There are various reasons why patients may not be able to undergo surgery4

Medical therapy should be considered in patients who are not candidates for surgery or have failed surgery.1,2 A prospective study of 471 patients with nonfunctioning adrenal adenomas revealed that most patients did not undergo surgery, even when it was clinically indicated.4

75% of patients with hypercortisolism did not undergo clinically indicated adrenalectomy.

MANAGING THE IMPACT OF ELEVATED CORTISOL LEVELS WITH MEDICAL THERAPY

There are several therapies with varying mechanisms of action to manage the impact of elevated cortisol. It is important to find the right medical therapy to meet individual patient needs.1

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Modulate cortisol activity by competing with cortisol at the glucocorticoid receptor5

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Inhibit key enzymes needed to produce cortisol6,7

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Target key cells in pituitary adenomas to inhibit adrenocorticotropic hormone secretion8

CONSIDERATIONS TO OPTIMIZE MEDICAL MANAGEMENT

Medical therapy can address hyperglycemia related to endogenous hypercortisolism.5

  • Medical therapy for hypercortisolism is not intended to replace medications that manage comorbidities; however, the dosage may decrease and/or discontinue9
  • Dose adjustments to medications and continued monitoring may be required9
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References

1. Fleseriu M, Auchus R, Bancos I, et al. Lancet Diabetes Endocrinol. 2021;9(12):847-875. doi:10.1016/S2213-8587(21)00235-7 2. Zeiger MA, Thompson GB, Duh QY, et al. Endocr Prac. 2009;15(suppl 1):1-20. doi:10.4158/EP.15.S1 3. Tritos NA, Biller BM, Swearingen B. Nat Rev Endocrinol. 2011;7:279-289 4. Petramala L, Olmati F, Concistrè A, et al. Endocrine. 2020;70(1):150-163. doi:10.1007/s12020-020-02297-2 5. Korlym [prescribing information]. Menlo Park, CA: Corcept Therapeutics, Incorporated; November 2019. 6. Recorlev [prescribing information]. Chicago, IL: Xeris Pharmaceuticals, Incorporated; 2023. 7. Isturisa [prescribing information]. Lebanon, NJ: Recordati Rare Disease, Incorporated; 2020. 8. SIGNIFOR LAR [prescribing information]. Lebanon, NJ: Recordati Rare Disease, Incorporated; 2023. 9. Scaroni C, Zilio M, Foti M, Boscaro M. Endocr Rev. 2017;38(3):189-219. doi:10.1210/er.2016-1105