Major Research Findings

Cushing's disease is often treated with medications, including steroidogenesis inhibitors, which aim to control excessive cortisol production. 2 , 1 . These drugs are used when surgery is unsuccessful or impossible, when waiting for the maximum effect of radiation therapy, or in other situations. While these medications can achieve biochemical control in over 50% of cases, daily management of these drugs can be complex due to the need for dose titration or a ‘block and replace’ approach, making it difficult to define the desired cortisol levels. Moreover, each drug has its own side effects, which require careful monitoring. 1

Reasons for Side Effects

Steroidogenesis inhibitors work by inhibiting the production of cortisol, but they can also affect the production of other hormones in the body. This can lead to various side effects. 2 , 1 .

Common Side Effects

Gastrointestinal

Steroidogenesis inhibitors can affect the gastrointestinal system. 2 , 1 . Side effects may include nausea, vomiting, abdominal pain, and diarrhea.

Liver

Steroidogenesis inhibitors can affect liver function. 2 , 1 . Side effects may include abnormal liver function tests and jaundice.

Kidney

Steroidogenesis inhibitors can affect kidney function. 2 , 1 . Side effects may include abnormal kidney function tests.

Endocrine

Steroidogenesis inhibitors can affect the endocrine system. 2 , 1 . Side effects may include abnormalities in sex hormones and thyroid function.

Other

Steroidogenesis inhibitors can cause other side effects. 2 , 1 . These may include headache, dizziness, fatigue, and skin abnormalities.

Side Effects Management

Gastrointestinal

Gastrointestinal side effects can be addressed through dietary changes and medication. 2 , 1 . For example, if nausea and vomiting are severe, patients may need to eat smaller, more frequent meals and take anti-nausea medication.

Liver

If liver side effects occur, the steroidogenesis inhibitor may need to be stopped or the dosage reduced. 2 , 1 . Medication to improve liver function may also be used.

Kidney

If kidney side effects occur, the steroidogenesis inhibitor may need to be stopped or the dosage reduced. 2 , 1 . Medication to improve kidney function may also be used.

Endocrine

Endocrine side effects can be managed with hormone replacement therapy. 2 , 1 . For example, if abnormalities in sex hormones occur, medication to replace the missing hormones may be prescribed.

Other

Other side effects are treated according to the specific symptoms. 2 , 1 . For example, if severe headaches occur, pain medication may be prescribed.

Comparison of Studies

Commonalities

Both studies indicate that steroidogenesis inhibitors are effective in treating Cushing's disease, but they also highlight the risk of side effects. 2 , 1 .

Differences

The two studies differ in the range of steroidogenesis inhibitors examined. The first paper examined seven drugs, including levoketoconazole, while the second examined four drugs, also including levoketoconazole. The first paper focused on managing side effects, while the second focused on the clinical management of steroidogenesis inhibitors. 2 , 1 .

Considerations for Real-Life Application

It is important to be aware of the potential side effects of steroidogenesis inhibitors, even though they can be effective in treating Cushing's disease. 2 , 1 . Before starting treatment, it is crucial to discuss the risks and benefits with your doctor. If you notice any side effects, consult your doctor immediately.

Limitations of Current Research

These studies suggest that larger studies are needed to investigate the frequency and severity of side effects from steroidogenesis inhibitors. 2 , 1 .

Future Research Directions

Further research is needed to investigate the long-term effects of side effects from steroidogenesis inhibitors. 2 , 1 . It is also essential to develop further guidelines for the safe and effective use of steroidogenesis inhibitors.

Conclusion

Steroidogenesis inhibitors can be effective in treating Cushing's disease, but they carry the risk of side effects. 2 , 1 . It is vital to discuss the risks and benefits with your doctor before starting treatment and to consult your doctor immediately if you notice any side effects.