Cushing syndrome

Clinical state caused by chronically elevated glucocorticoid levels. Causes: pituitary adenoma (Cushing disease), ectopic ACTH secretion, adrenal tumors, prolonged exogenous glucocorticoid intake.

ICD-10 E241 drug

Also known as: Hypercortisolism, Endogenous hypercortisolism

Drugs used for this condition

BKetoconazoleSecond line · Systemic antimycotics. Imidazole derivativesKetoconazole is used off-label in endogenous Cushing syndrome to suppress cortisol synthesis when surgery is not feasible or is incomplete. The effect appears in 1–4 weeks at 400–1200 mg daily. In Europe, Ketoconazole HRA has been registered for this indication since 2014; in the US, use is off-label. Therapy requires lifelong ALT, AST and ALP monitoring and regular cortisol assessment.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit