Titre:	A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism
Auteur(s):	Machado, Márcio Carlos Fragoso, Maria Candida Barisson Vilares Moreira, Ayrton Custódio Boguszewski, César Luiz Vieira Neto, Leonardo Naves, Luciana Ansaneli Vilar, Lucio Araújo, Luiz Antônio de Musolino, Nina Rosa Castro Miranda, Paulo Augusto C. Czepielewski, Mauro Antonio Gadelha, Monica R. Bronstein, Marcello Delano Ribeiro-Oliveira Jr., Antônio
Assunto::	Cushing, Doença de Síndrome de Cushing
Date de publication:	2018
Editeur:	Sociedade Brasileira de Endocrinologia e Metabologia
Référence bibliographique:	MACHADO, Márcio Carlos et al. A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism. Archives of Endocrinology and Metabolism, São Paulo, v. 62, n. 1, p. 87-105, fev. 2018. DOI: http://dx.doi.org/10.20945/2359-3997000000014. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000100087&lng=en&nrm=iso. Acesso em: 21 fev. 2019.
Abstract:	The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure. Medical treatment, radiotherapy and adrenalectomy are the other options when transsphenoidal pituitary surgery fails. There are several options of medical treatment, although cabergoline and ketoconazole are the most commonly used alone or in combination. Novel treatments are also addressed in this review. Different therapeutic approaches are frequently needed on an individual basis, both before and, particularly, after surgery, and they should be individualized. The objective of the present review is to provide the necessary information to achieve a more effective treatment for CD. It is recommended that patients with CD be followed at tertiary care centers with experience in treating this condition.
metadata.dc.description.unidade:	Faculdade de Medicina (FMD)
Licença::	(CC BY) - This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Fonte: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000100087&lng=en&nrm=iso. Acesso em: 21 fev. 2019.
DOI:	http://dx.doi.org/10.20945/2359-3997000000014
Collection(s) :	Artigos publicados em periódicos e afins

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