Treatment of Recurrence/Persistence of Cushing Disease: Role of Medical Therapy

Seung Shin ParkSouth Korea Speaker Treatment of Recurrence/Persistence of Cushing Disease: Role of Medical TherapyCushing’s disease (CD) remains a challenging disorder despite advances in pituitary surgery, as a substantial proportion of patients experience persistent or recurrent hypercortisolism following initial treatment. In these clinical settings, medical therapy has emerged as a central component of disease management. Recent international collaborative efforts, including a joint consensus statement developed by the Korean Endocrine Society and the Japan Endocrine Society, emphasize the expanding role of pharmacologic treatment across multiple stages of CD care. This lecture provides a practical overview of contemporary medical therapies for persistent or recurrent CD based on a mechanism-oriented framework. Tumor-directed therapies aimed at suppressing adrenocorticotropic hormone secretion, including cabergoline and pasireotide, will be discussed in the context of patient selection and regional practice differences. Adrenal-directed steroidogenesis inhibitors—particularly osilodrostat, ketoconazole, and metyrapone—will be reviewed with emphasis on clinical positioning, efficacy, and safety considerations. In addition, the unique therapeutic role of glucocorticoid receptor antagonism with mifepristone will be highlighted, focusing on indications and monitoring challenges distinct from cortisol-lowering therapies. Special attention will be given to real-world treatment strategies, including drug selection, combination therapy, and region-specific clinical considerations in Asian populations. Key concepts from the upcoming treatment consensus will be integrated to provide a clinically applicable framework for individualized management. This session aims to offer a practical, consensus-informed approach to optimizing medical therapy in patients with persistent or recurrent Cushing’s disease.