Cushing syndrome
Also known as: Cushing disease · hypercortisolism
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Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline
Endocrine Society · 2015
This Endocrine Society guideline covers how to treat endogenous Cushing's syndrome once diagnosed, including choice of primary therapy, management of comorbidities and second-line options.
Consensus on Diagnosis and Management of Cushing's Disease: A Guideline Update
Pituitary Society · 2021
An international consensus workshop convened by the Pituitary Society updated guidance on screening, diagnosis and treatment of Cushing's disease, the commonest cause of endogenous Cushing's syndrome.
US vs EU key differences
- Scope differs: the 2015 Endocrine Society guideline covers treatment across all causes of endogenous Cushing's syndrome and does not address diagnosis, while the 2021 Pituitary Society consensus is restricted to Cushing's disease and covers screening and diagnosis as well as treatment. source
- Both converge on surgical resection of the causal lesion as first-line therapy, with transsphenoidal surgery by an experienced pituitary surgeon achieving remission in roughly 80% of microadenoma cases. source
- The 2021 consensus declines to rank the three screening tests, saying overnight dexamethasone suppression, 24-hour urinary free cortisol and late-night salivary cortisol may each be used first depending on local availability. source
- The 2021 update reflects a drug landscape the 2015 guideline predates, laying out steroidogenesis inhibitors including osilodrostat alongside pituitary-directed pasireotide and cabergoline and glucocorticoid-receptor blockade with mifepristone. source
- The Pituitary Society consensus adds an explicit long-term surveillance stance, recommending lifelong monitoring for recurrence with annual late-night salivary cortisol once the HPA axis has recovered. source
What changed recently
- GLOBAL2015 → 20212021-12-01
This update to the earlier (2003, 2008 and 2015) consensus documents moved late-night salivary cortisol to the front line for screening and recurrence detection, advised measuring dexamethasone levels alongside cortisol to cut false-positive suppression tests, and incorporated newly approved medical therapies such as osilodrostat and mifepristone into the treatment algorithm. It also set an expectation of lifelong monitoring for recurrence and persistent comorbidity after surgery.
See the full update feed for changes across every system.