CUSHINGS-DISEASE - THERAPY OF PITUITARY-ADENOMAS

The treatment of Cushing's disease has evolved over the past 20 years from the era of bilateral adrenalectomy to the current era of pituitar y microsurgery.(5, 32, 53, 68) Therapy directed to the pituitary is cu rrently the first approach in Gushing's disease and transsphenoidal ex ploration of the sellar contents is the procedure of choice.(40, 42) P ituitary microsurgery is successful in the majority of patients with m icroadenomas but considerably less so in those with larger or invasive tumors. In these latter patients, radiotherapy is usually the modalit y of second choice and may be combined with medical therapy to inhibit adrenal cortisol production or less commonly medical therapy to inhib it adrenocorticotropic hormone (ACTH) secretion. Primary treatment wit h the various techniques of delivering radiation to the sella turcica is rarely used at present and the pharmacologic inhibition of ACTH sec retion has been largely unsuccessful, as discussed later.