Cushing syndrome

Exogenous Cushing syndrome may be prevented in patients who require exogenous corticosteroid treatment, by reducing corticosteroid use to an absolute minimum required dose and frequency whenever possible.

No specific exposures or modifiable factors have been identified that cause endogenous hypercortisolism.

Standard testing, follow-up, and management for associated conditions of hypertension, diabetes, and osteoporosis should be undertaken, as these conditions may persist after effective treatment of hypercortisolism. Cardiovascular disease is the major cause of mortality in patients with Cushing syndrome.[114]De Tommasi C, Vance ML, Okonkwo DO, et al. Surgical management of adrenocorticotropic hormone-secreting macroadenomas: outcome and challenges in patients with Cushing's disease or Nelson's syndrome. J Neurosurg. 2005 Nov;103(5):825-30. http://www.ncbi.nlm.nih.gov/pubmed/16304985?tool=bestpractice.com ​ It is difficult to tell if the increase in cardiovascular mortality is due to the development of traditional risk factors such as hypertension, diabetes, and dyslipidaemia, or to hypercortisolism itself.[122]Park J, De Luca A, Dutton H, et al. Cardiovascular outcomes in autonomous cortisol secretion and nonfunctioning adrenal adenoma: a systematic review. J Endocr Soc. 2019 May 1;3(5):996-1008. https://academic.oup.com/jes/article/3/5/996/5418930 http://www.ncbi.nlm.nih.gov/pubmed/31065617?tool=bestpractice.com ​ Risk factor modification and resolution of hypercortisolism are the keys to lowering cardiovascular mortality.

Standard cardiovascular screening and treatment should be applied to patients with Cushing syndrome.