: Endogenous Cushing’s syndrome is a grave disease that requires a multidisciplinary and individualized treatment approach
for each patient. Approximately 80% of all patients harbour a corticotroph pituitary adenoma (Cushing’s disease) with excessive secretion
of
adrenocorticotropin-hormone
(ACTH)
and,
consecutively,

cortisol. The goals of treatment include normalization of hormone
excess, long-term disease control and the reversal of comorbidities caused by the underlying pathology. The treatment of choice is neurosurgical
tumour
removal
of
the
pituitary
adenoma.
Second-line
treatments
include
medical
therapy,
bilateral
adrenalectomy
and
radiation
therapy.
Drug
treatment
modalities
target
at
the
hypothalamic/pituitary
level,
the
adrenal
gland
and
at
the
glucocorticoid
receptor

level
and
are
commonly
used
in
patients
in
whom
surgery
has
failed.
Bilateral
adrenalectomy
is
the
second-line
treatment
for
persistent

hypercortisolism
that
offers
immediate
control
of
hypercortisolism.
However,

this treatment option requires a careful individualized
evaluation, since it has the disadvantage of permanent hypoadrenalism which requires lifelong glucocorticoid and mineralocorticoid
replacement therapy and bears the risk of developing Nelson’s syndrome. Although there are some very promising medical therapy
options it clearly remains a second-line treatment option. However, there are numerous circumstances where medical management of
CD is indicated. Medical therapy is frequently used in cases with severe hypercortisolism before surgery in order to control the metabolic
effects
and
help
reduce
the
anestesiological
risk.
Additionally,
it
can
help
to
bridge
the
time
gap
until
radiotherapy
takes
effect.
The

aim
of this review is to analyze and present current treatment options in Cushing’s
disease