Background

Cushing’s syndrome (CS) is a disorder caused by excess cortisol production. It is three times more often seen in female than male patients, and overall, it is observed in 2–3 per million/year. In nearly 70% of cases, this is due to a pituitary tumour secreting adrenocorticotropic hormones. The first-line approach to treat these cases is the surgical removal of the tumour. However, in nearly a quarter of cases, this proves ineffective. These patients should be then treated with pharmacotherapy, while untreated CS may be lethal. The most numerous groups of pharmaceutics in CS treatment are steroidogenesis inhibitors.

Objectives

The purpose of this article is to review the latest publications from 2015 to 2022, which state the medical approach with steroidogenesis inhibitors to inoperative CS, the advantages, as well potential burdens and adverse effects of this pharmacological treatment.

Material and methods

A review of literature regarding adrenal steroidogenesis inhibitors was performed using the PubMed database; the search terms Cushing’s syndrome, inoperative, ketoconazole, levoketoconazole, metyrapone, mitotane, etomidate, and osilodrostat were applied.

Results and conclusions

This review states the current data pertaining to the effectiveness of hypercortisolaemia treatment, as well as the potential adverse effects of ketoconazole, levoketoconazole, metyrapone, mitotane, etomidate, osilodrostat – steroidogenesis inhibitors currently used in the therapy of nonoperative Cushing’s syndrome.