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Título: A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism
Autor(es): 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 A.
Gadelha, Monica R.
Bronstein, Marcello Delano
Ribeiro-Oliveira Jr., Antônio
Assunto: Cushing, Doença de
Síndrome de Cushing
Data de publicação: 2018
Editora: Sociedade Brasileira de Endocrinologia e Metabologia
Referência: 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: Disponível em: 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.
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: Acesso em: 21 fev. 2019.
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