Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Rua Clovis Silveira Barros, 84/1202, Boa Vista, Recife, CEP 50.050-270, Brazil,
Pituitary. 2015 Apr;18(2):253-62. doi: 10.1007/s11102-015-0641-x.
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.
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.
对于库欣病（CD）的管理，医学治疗越来越受到关注，特别是在持续性或复发性皮质醇过多症的情况下。酮康唑，一种肾上腺类固醇生成抑制剂，是最广泛使用的药物，而卡麦角林和培高利特是最有前途的中枢作用药物。本文的主要目的是强调 CD 的治疗选择，特别强调联合治疗，这是一个仅由少数研究涉及的主题。
根据这些研究的结果，涉及对 ACTH 和皮质醇分泌具有相加或协同作用的药物的联合治疗似乎非常有吸引力，因为它们以较低的剂量、较低的副作用发生率和可能较低的治疗逃避率产生更高的长期控制皮质醇过多症的可能性。目前，酮康唑、卡麦角林和培高利特是联合使用的最佳药物。
