University Of California Los Angeles
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Are people with Cushing’s disease refractory to surgery and radiotherapy better served with long-term pharmacotherapy or bilateral adrenalectomy?

The Endocrine Society recommends medical management with a moderate level of evidence; in particular, steroidogenesis inhibitors as a second-line treatment after surgery for people with Cushing’s disease, either with or without radiotherapy, and as primary treatment for ectopic adrenocorticotropic hormone (ACTH) secretion. The guideline also recommends pituitary-directed medical treatments for patients who are not surgical candidates or who have persistent disease after surgery. The choice of medical therapy should be guided by efficacy, individual patient factors and cost.