Figure 1. Suggested Algorithm for the Treatment of Cushing's
Syndrome
Treat Comorbidities
Cushing's Syndrome and Etiology Established Biochemically
ACTH-Dependent CS ACTH-Independent CS
Presumed EAS,
Imaging:
No Tumor
Presumed CD
Based on IPSS or
>6 mm Mass
Adrenal Imaging
Remission
Tumor
Resection
Unilateral or Bilateral Adx
Presumed EAS,
Imaging: + Tumor
Treat
Metastatic
Disease if
Applicable
Remission
Failed Surgery, No Surgery,
or Recurrence
Resection not
possible
Monitor for
Recurrence
Control Hypercortisolism
If CD, Consider:
• Repeat TSS
• Pituitary-Directed Medical Treatment
• RT and Steroidogenesis Inhibitors
For All Etiologies, Consider:
• Steroidogenesis Inhibitors
• GC Receptor Antagonist
• Bilateral Adx
Repeat
Localization
Studies
LEGEND
• Treatment recommendation
• Evaluation
• Status or result
Treatment
