Treatment of Severe Cushing's Disease with Potentially Life-Threatening Complications
Clinical scenario
Severe Cushing's disease — characterised by marked hypercortisolism — with potentially life-threatening metabolic, psychiatric, infectious, or cardiovascular/thromboembolic complications represents a clinical emergency. Urgently restoring cortisol to safe levels is the central priority.
Who this applies to
Patients with severe Cushing's disease who present with or are at high risk of life-threatening metabolic crises, severe psychiatric disturbance, serious infection, or cardiovascular/thromboembolic events. In select cases, this population may also benefit from preoperative medical therapy.
Treatment approach — partial overview
Management is centred on rapid-acting adrenal steroidogenesis inhibition to bring cortisol down as quickly as possible. The complete agent selection criteria, sequencing, and clinical decision algorithm are available in the full structured protocol.
Clinical goal
Rapid normalization of cortisol levels.
References
DOI: 10.1016/S2213-8587(21)00235-7
- For patients with severe disease, rapid normalization of cortisol is the most important goal.
- Patients with severe CD who have potentially life-threatening metabolic, psychiatric, infectious, or cardiovascular/thromboembolic complications also may benefit from preoperative medical therapy in select cases.
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