부신겉질 자극 호르몬 분비 코티코 트로피 선종으로 인한 쿠싱 병 치료
What is the recommended initial therapy for Cushing’s disease caused by a corticotropin-secreting corticotroph adenoma?
NEJM 3/5/2020 에서 퍼온글
Selective transsphenoidal adenomectomy is recommended as initial therapy for Cushing’s disease, with remission achieved in approximately 75% of patients and recurrence seen in approximately 10%. Although more radical surgery offers the potential for total adenoma resection, complication rates are higher and pituitary damage is more likely with total resection. Radiation therapy may control the disease, but the efficacy of this treatment is delayed for several years, and approximately 30% of patients have a relapse. Adrenalectomy may immediately reverse hypercortisolism. However, lifelong replacement of adrenal hormones is challenging. Adrenal-targeted medical therapy may offer clinical and biochemical improvement, but most studies of such treatment have not been rigorously controlled, and the results are often inconsistent.