A reappraisal of the medical therapy with steroidogenesis inhibitors in Cushing's syndrome

Objective To evaluate the outcome of preoperative therapy with ketoconazole (KTZ) and/or metyrapone (MTP) in previously untreated patients with Cushing's syndrome (CS). Design and patients Sixty-two patients with CS (85% ACTH dependent), treated with steroidogenesis inhibitors prior to surgery between 1983 and 2010, were retrospectively studied. T0 and t1 defined baseline and end of preoperative medical treatment. Results Outcomes were based upon clinical and biochemical (normal UFC) control of hypercortisolism at t1: group CO (controlled) included 20 patients (32%) with eucortisolism and significant clinical improvement; group NC (not controlled) 30 (48%) with persistent hypercortisolism and no control of symptoms; and group PC (partially controlled) 12 patients (19%) who despite eucortisolism had no real clinical improvement. Median duration of treatment was 4 similar to months (range: 130.7), and median cumulative dose of KTZ and MTP was 57 similar to g (range: 3.6240) and 120 similar to g (range: 7.51215). CO patients were treated more with KTZ alone than the other groups (P similar to