Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

• Published in: The journal of clinical endocrinology and metabolism Vol. 100; no. 8; pp. 2807 - 2831
• Main Authors: Nieman, Lynnette K, Biller, Beverly M. K, Findling, James W, Murad, M. Hassan, Newell-Price, John, Savage, Martin O, Tabarin, Antoine
• Format: Journal Article
• Language: English
• Published: United States Endocrine Society 01-08-2015; Copyright by The Endocrine Society
• Series: Clinical Practice Guideline
• Subjects: Adrenal Gland Neoplasms - drug therapy; Adrenal Gland Neoplasms - radiotherapy; Adrenal Gland Neoplasms - surgery; Adrenalectomy; Consensus; Cushing Syndrome - therapy; Endocrinology - standards; Evidence-Based Medicine; Humans; Patient Care Planning; Pituitary Neoplasms - drug therapy; Pituitary Neoplasms - radiotherapy; Pituitary Neoplasms - surgery; Recurrence; Remission Induction
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2015-1818

Objective:
The objective is to formulate clinical practice guidelines for treating Cushing's syndrome.
Participants:
Participants include an Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer. The European Society for Endocrinology co-sponsored the guideline.
Evidence:
The Task Force used the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Consensus Process:
The Task Force achieved consensus through one group meeting, several conference calls, and numerous e-mail communications. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines.
Conclusions:
Treatment of Cushing's syndrome is essential to reduce mortality and associated comorbidities. Effective treatment includes the normalization of cortisol levels or action. It also includes the normalization of comorbidities via directly treating the cause of Cushing's syndrome and by adjunctive treatments (eg, antihypertensives). Surgical resection of the causal lesion(s) is generally the first-line approach. The choice of second-line treatments, including medication, bilateral adrenalectomy, and radiation therapy (for corticotrope tumors), must be individualized to each patient.