Early detection of hypercortisolism and initiation of treatment are essential for preventing or remedying the comorbidities linked to hypercortisolism as well as reducing the risk of death in these patients. Treatment options for patients with hypercortisolism include surgery, radiotherapy, and direct medical therapy.1
Surgery is generally the primary therapy for endogenous hypercortisolism. Transsphenoidal surgery (TSS), a type of surgery in which an endoscope and/or surgical instruments are directed through the nose to the bottom of the skull where the pituitary gland is located, remains the first-line treatment for Cushing disease. Adrenalectomy is an additional surgical option that involves completely or partially removing one or both of the adrenal glands. This treatment results in immediate resolution of hypercortisolism and may involve lifelong hormone replacement therapy.2,3
Although surgery is generally the first-line therapy for endogenous hypercortisolism, for patients who have failed surgery or for those who are not candidates for surgery, medical therapy plays an important role in managing the effects of hypercortisolism.1,3
Remission after surgery is indicated by postoperative adrenal insufficiency due to suppression of normal corticotropin cell production of adrenocorticotropic hormone (ACTH) in the postoperative period; it may take years for the hypothalamic–pituitary–adrenal (HPA) axis to recover.9
Criteria for disease remission vary, but may include the following9:
All patients will need lifelong, yearly evaluation for recurrance.* Late night salivary cortisol is the preferred initial test and best predictor of recurrence.9*The timeline of repeat testing will depend on clinical circumstances.