Division of Endocrinology, Diabetes and Metabolism, New York University Langone Medical Center, New York, NY 10016, United States.
Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland.
Eur J Endocrinol. 2024 Aug 30;191(3):R37-R54. doi: 10.1093/ejendo/lvae110.
The first-line treatment for Cushing's disease is transsphenoidal adenomectomy, which can be curative in a significant number of patients. The second-line options in cases of failed primary pituitary surgery include repeat surgery, medical therapy, and radiation. The role for medical therapy has expanded in the last decade, and options include pituitary-targeting drugs, steroid synthesis inhibitors, and glucocorticoid receptor antagonists. Bilateral adrenalectomy is a more aggressive approach, which may be necessary in cases of persistent hypercortisolism despite surgery, medical treatment, or radiation or when rapid normalization of cortisol is needed. We review the available treatment options for Cushing's disease, focusing on the second-line treatment options to consider after failed primary pituitary surgery.
库欣病的一线治疗方法是经蝶窦腺瘤切除术，该方法可以治愈相当一部分患者。在初次垂体手术失败的情况下，二线选择包括再次手术、药物治疗和放射治疗。在过去十年中，药物治疗的作用不断扩大，包括针对垂体的药物、类固醇合成抑制剂和糖皮质激素受体拮抗剂。双侧肾上腺切除术是一种更为激进的方法，在手术、药物治疗或放射治疗后皮质醇仍持续升高、或需要快速使皮质醇正常化的情况下可能需要采用这种方法。我们综述了库欣病的现有治疗选择，重点关注初次垂体手术后失败时需要考虑的二线治疗选择。
