Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations
- PDF / 1,745,821 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 76 Downloads / 189 Views
(2020) 6:18
REVIEW ARTICLE
Open Access
Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations David R. Brown1, Honey E. East2, Bradley S. Eilerman3, Murray B. Gordon4, Elizabeth E. King5, Laura A. Knecht6, Brandon Salke7, Susan L. Samson8, Kevin C. J. Yuen9 and Hanford Yau10*
Abstract Background: While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing Syndrome) trial. Mifepristone is a competitive glucocorticoid receptor antagonist and progesterone receptor antagonist that is associated with several treatment effects and adverse events that clinicians need to be aware of when considering its use. The objective of this review was to provide updated clinical management recommendations for patients with CS treated with mifepristone. Methods: A panel of endocrinologists from the US with extensive experience in treating patients with CS, including with mifepristone, convened as part of a clinical advisory board to develop a consensus on the practical, real-world clinical management of patients on mifepristone. Results: Comprehensive considerations and recommendations are provided for managing mifepristone-associated effects, including symptoms of cortisol withdrawal, hypokalemia, and change in thyroid function; effects related to its antiprogesterone activity; and rash. Additional management strategies to address concomitant medications and special clinical situations, such as surgery and use in specific populations, are also provided. Conclusion: Safe and effective use of mifepristone requires clinical judgment and close patient monitoring to ensure optimal clinical outcomes. These consensus recommendations provide useful, practical guidance to clinicians using mifepristone. Keywords: Cushing syndrome, Drug effects, Education
Introduction Surgical resection of the underlying tumor is first-line therapy for patients with endogenous hypercortisolism caused by Cushing syndrome (CS), regardless of its etiology [1]. Medical treatment options, including * Correspondence: [email protected] 10 Division of Endocrinology, Diabetes, and Metabolism, The University of Central Florida College of Medicine, 13800 Veterans Way, Orlando, FL 32827, USA Full list of author information is available at the end of the article
pituitary-directed agents, steroid synthesis inhibitors, and glucocorticoid receptor (GR) antagonists, may be used to treat persistent or recurrent disease if surgery fails, or if surgery is not feasible [1, 2]. Medical therapy may also be used as an adjunctive bridge therapy to pituitary radiation while awaiting the effects of radiation [3], and as a preoperative treatment to address the effects of severe hypercortisolism and associated complications [4].
© The Author(s). 2020 Open Access This article is licensed
Data Loading...
