The differential diagnosis and treatment of Cushing's syndrome

库欣综合征的治疗最近由内分泌学会制定的指南进行了讨论。 这些表明，最佳的治疗方法，如果可能的话，是手术切除的致病肿瘤（S）。 当这是不可能的，或患者复发，二级治疗库欣病包括放射治疗与连续使用皮质醇降低药物，或肿瘤导向的药物治疗，如卡麦角林，或帕瑞肽或糖皮质激素受体导向的治疗与米非司酮。 异位ACTH分泌的患者可能患有隐匿性或广泛转移的肿瘤，这两种肿瘤都不适合手术治疗。 在这种情况下，药物治疗与皮质醇降低药物或米非司酮，或双侧肾上腺切除术，可以选择。 治疗应根据每个患者的情况、表现、目标和价值观进行个性化。 除了主要的肿瘤导向治疗外，还应解决合并症。

The treatment of Cushing's syndrome was addressed recently by guidelines developed by the Endocrine Society. These indicate that the optimal treatment, when possible, is surgical resection of the causative tumor(s). When this is not possible, or the patient recurs, secondary treatment in Cushing's disease involves radiation therapy with adjunctive use of cortisol-lowering medications, or tumor-directed medical therapy such as cabergoline, or pasireotide or glucocorticoid receptor-directed treatment with mifepristone. Patients with ectopic ACTH secretion may have an occult or widely metastatic tumor, neither of which is amenable to surgical treatment. In this case, medical therapy with cortisol -lowering medications or mifepristone, or bilateral adrenalectomy, may be chosen. Treatments should be individualized to the circumstances, presentation, goals and values of each patient. Co-morbidities should be addressed in addition to primary tumor-directed therapy.