REVIEW   

Minerva Endocrinologica 2019 June;44(2):205-20

DOI: 10.23736/S0391-1977.17.02771-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Different therapeutic options in patients with Cushing’s syndrome due to bilateral macronodular adrenal hyperplasia

Nora M. ALBIGER ¹ ✉, Daniela REGAZZO ¹, Maurizio IACOBONE ², Carla SCARONI ¹

¹ Unit of Endocrinology, Department of Medicine DIMED, University of Padua, Padua, Italy; ² Unit of Endocrine Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

Bilateral macronodular adrenal hyperplasia (BMAH) is a relatively rare cause of Cushing’s Syndrome (CS). In recent years, growing evidence has shown that steroidogenesis is regulated by aberrant G-protein-coupled receptors (GPCRs) expression and their ligands, in a significant proportion of patients with BMAH. The screening of patients with overt or subclinical CS demonstrates the frequent expression of several GPCRs that opened the option to potential therapeutic applications. Thus, several studies have demonstrated that targeting the involved receptor with specific antagonists may result in a more or less effective control of cortisol excess. Bilateral adrenalectomy has traditionally been considered the treatment of choice for BMAH. However, unilateral adrenalectomy has been recently proposed as an alternative in selective patients to avoid the long-term necessity of gluco/mineralocorticoid replacement. Adrenal steroidogenesis inhibitors remain a valid option when medical treatment is needed due to high surgical risk.

KEY WORDS: Adrenal glands - Cushing Syndrome - Therapeutics