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Practice Guideline
. 2015 Aug;100(8):2807-31.
doi: 10.1210/jc.2015-1818. Epub 2015 Jul 29.

Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

Lynnette K Nieman  1 , Beverly M K Biller  1 , James W Findling  1 , M Hassan Murad  1 , John Newell-Price  1 , Martin O Savage  1 , Antoine Tabarin  1 ; Endocrine Society
Affiliations
Practice Guideline

Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline

Lynnette K Nieman et al. J Clin Endocrinol Metab. 2015 Aug.

Abstract

Objective: The objective is to formulate clinical practice guidelines for treating Cushing's syndrome.

Participants: Participants include an Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer. The European Society for Endocrinology co-sponsored the guideline.

Evidence: The Task Force used the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews and used the best available evidence from other published systematic reviews and individual studies.

Consensus process: The Task Force achieved consensus through one group meeting, several conference calls, and numerous e-mail communications. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines.

Conclusions: Treatment of Cushing's syndrome is essential to reduce mortality and associated comorbidities. Effective treatment includes the normalization of cortisol levels or action. It also includes the normalization of comorbidities via directly treating the cause of Cushing's syndrome and by adjunctive treatments (eg, antihypertensives). Surgical resection of the causal lesion(s) is generally the first-line approach. The choice of second-line treatments, including medication, bilateral adrenalectomy, and radiation therapy (for corticotrope tumors), must be individualized to each patient.

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Figures

Figure 1.
Figure 1.
An algorithm for the treatment of CS. Derived from Nieman LK, Biller BM, Finding, JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526–1540. (17)
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