RESUMO
Los farmacos que en la actualidad estan mereciendo mas atencion son aquellos con accion directa sobre el tumor inhibiendo la secrecion de ACTH: analogos de la somatostatina (..) (AU)
Hypercortisolism induced by Cushing disease causes high morbidity and mortality.The treatment of choice is pituitary surgery, but it often fails to achieve cure, and othertreatment modalities (radiotherapy, bilateral adrenalectomy) may therefore be required. Ifthese treatments are not effective or while waiting for their results, hypercortisolism shouldbe controlled with drugs.The classical drug treatments are those that act by inhibiting cortisol secretion by the adrenalgland (ketoconazole, metyrapone, mitotane, etomidate). The preliminary results of a new drug (LCI699) which is a potent enzyme inhibitor of cortisolsecretion have been reported.A clinical trial of the safety and efficacy of mifepristone, a glucocorticoid receptor antagonist,has just been published.The drugs deserving more attention today are those with a direct action on the tumor by inhibiting ACTH secretion: somatostatin analogues (pasireotide), dopamine agonists (cabergoline),PPAR- , and retinoic acid.A special review is made of the available clinical trials with pasireotide and cabergoline (AU)
Assuntos
Humanos , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Glucocorticoides/antagonistas & inibidores , Hormônio Adrenocorticotrópico/antagonistas & inibidores , Hiperfunção Adrenocortical/complicações , Dopaminérgicos/uso terapêutico , Somatostatina/uso terapêuticoRESUMO
Hypercortisolism induced by Cushing disease causes high morbidity and mortality. The treatment of choice is pituitary surgery, but it often fails to achieve cure, and other treatment modalities (radiotherapy, bilateral adrenalectomy) may therefore be required. If these treatments are not effective or while waiting for their results, hypercortisolism should be controlled with drugs. The classical drug treatments are those that act by inhibiting cortisol secretion by the adrenal gland (ketoconazole, metyrapone, mitotane, etomidate). The preliminary results of a new drug (LCI699) which is a potent enzyme inhibitor of cortisol secretion have been reported. A clinical trial of the safety and efficacy of mifepristone, a glucocorticoid receptor antagonist, has just been published. The drugs deserving more attention today are those with a direct action on the tumor by inhibiting ACTH secretion: somatostatin analogues (pasireotide), dopamine agonists (cabergoline), PPAR-γ, and retinoic acid. A special review is made of the available clinical trials with pasireotide and cabergoline.