Posttreatment Management of Cushing's Disease

Transsphenoidal surgery is the first-line treatment for Cushing's disease. Successful removal of the adrenocorticotropic hormone-secreting pituitary tumor requires cautious follow-up because of the postoperative onset of adrenal insufficiency. Furthermore, possible surgical complications, such as diabetes insipidus and pituitary insufficiency, may occur. Despite an overall remission rate between 25% and 100% after primary surgery, disease persistence and recurrence are yet major clinical problems, and second-line therapies (alone or in combination) have to be considered, such as a wait-and-see approach, repeated neurosurgery, radiotherapy, radiosurgery, medical therapy, or adrenal surgery. Each of these approaches has strengths and limitations, and the choice has to be tailored to each clinical case, according to clinical, biochemical, and radiological data. Finally, despite persistent remission, long-term effects of hypercortisolism can affect the cardiovascular system as well as the skeletal system and the brain, with detrimental long-term sequelae.