Medical therapy for Cushing’s disease is suggested for the persistence of disease or recurrence after surgery and when surgery is not feasible it can also be used in selected cases of severe disease to control cortisol concentrations before surgery ( 2). Surgery may achieve complete remission in up to 80% of patients with microadenomas and 60% of patients with macroadenomas ( 5, 6).
The most common complications of hypercortisolism include hypertension, obesity, diabetes mellitus type 2, osteoporosis, capillary frailty and mood alterations.Īccording to the most recent consensus update on the diagnosis and management of Cushing’s disease, the first-line therapy is removing the pituitary adenoma via trans-nasal-sphenoidal (TNS) surgery ( 2, 3, 4). The first post-surgical biochemical assessment was equivocal in spite of a transient clinical hypoadrenalism, reverted after 2 months with the restoration of physiological hypothalamic-pituitary-adrenal axis (HPA) function.Ĭushing’s disease is a clinical condition caused by an adrenocorticotrophic hormone (ACTH) secreting pituitary adenoma, which can lead to numerous clinical and biochemical alterations caused by an excessive endogenous cortisol secretion ( 1). With osilodrostat, the patient reached biochemical and clinical control of disease until TNS surgery in October 2021, with complete remission. The second case reports a 32-year-old man diagnosed with Cushing’s disease in 2020, who, after surgery refusal, started osilodrostat at progressively up-titrated doses, according to 24 h urinary free cortisol levels, up to 5 mg twice a day. During treatment, progressive increase of ACTH levels and an enlargement of the pituitary remnant were documented, with planned radiosurgical treatment.
After non-curative trans-nasal-sphenoidal (TNS) surgery, due to a small remnant of the adenoma, medical therapy with osilodrostat achieved fast and effective biochemical and clinical response. The first report is about a 35-year-old woman with an adrenocorticotrophic hormone (ACTH)-secreting adenoma. For this reason, in this article, we will discuss two real-life cases of patients with Cushing’s disease treated with this drug. However, data collected from patients treated with osilodrostat in real-life settings still represents a small entity. A significant amount of the studies currently available in the literature focus on treatment in patients with Cushing’s disease. Osilodrostat is a novel, orally administered cortisol synthesis inhibitor, approved in 2020 by the European Medicines Agency (EMA) for the treatment of Cushing’s syndrome in adults.
0 kommentar(er)
