This handout is for cushing syndrome (endogenous + exogenous excluded). Your care team identified this based on: central obesity, moon facies, buffalo hump, purple striae, proximal myopathy, easy bruising (ada 2026).
Other reasons your team may use this plan: rapid weight gain, hirsutism, amenorrhea, mood change (ada 2026); new hypokalemic htn with new diabetes (ada 2026); incidental pituitary or adrenal mass (ada 2026).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ketoconazole | 200–400 mg BID, titrate | PO | BID/TID | Inhibits multiple steroidogenic enzymes; LFT mandatory (ADA 2026) |
| metyrapone | 250–500 mg q4h | PO | q4–6h | Rapid cortisol lowering; can cause adrenal insufficiency (ADA 2026) |
| osilodrostat | 2 mg BID, titrate | PO | BID | LINC-3; FDA-approved Cushing disease (ADA 2026) |
| mitotane | 500 mg BID, titrate to 1–4 g/d | PO | TID | Cytotoxic to adrenal cortex; ACC |
| mifepristone | 300 mg, titrate to 1200 mg | PO | daily | SEISMIC — improves glucose control; UFC unchanged (ADA 2026) |
| pasireotide | 600 mcg SC BID or 10–40 mg LAR IM monthly | SC/IM | BID or monthly | PASPORT; hyperglycemia common (ADA 2026) |
| cabergoline | 0.5 mg twice weekly, titrate | PO | 2× weekly | Off-label (ADA 2026) |
| hydrocortisone | 15–25 mg/day divided | PO | BID/TID | Replacement post-op or after enzyme inhibitor block-and-replace (Endocrine Society 2015 treatment guideline) |
Plan: Medical management bridge / unresectable / recurrence (ADA 2026)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Endo q3–6 mo; surveillance lifelong (Cushing disease recurrence ~20%) (ADA 2026)
Guideline: Endocrine Society 2008 Cushing diagnosis (Nieman); 2015 treatment; Pituitary Society 2021 Cushing disease consensus (Fleseriu)