Cushing’s Syndrome is one of the most intricate and complex of endocrine disorders. The process includes confirming hypercortisolemia, conducting differential diagnosis and localisation, implementing definitive treatments, addressing the need for further treatments, managing complications caused by excessive cortisol, and ensuring life-long follow-up: the disease imposes a significant burden.
This year marks a significant development in Australia with the inclusion of osilodrostat, a steroidogenesis inhibitor, in the PBS for the medical treatment of Cushing’s Syndrome. Previously, the medical management of Cushing’s Syndrome was restricted to a limited number of agents considered suitable only for short-term or bridging therapy before more definitive treatments such as surgery or radiotherapy. Their use was limited by factors such as cost, tolerance, and efficacy. The introduction of an efficacious steroidogenesis inhibitor that can be used long-term has established new treatment pathways, allowing for the control of hypercortisolemia at any stage of the management protocol, including primary therapy, secondary therapy, long-term therapy, and emergency therapy. This medication results in rapid lowering of cortisol levels, which necessitates management of glucocorticoid withdrawal syndrome (GWS) and potential cortisol deficiency. Effective management of these conditions requires patient engagement, education, and support, where endocrine nurses and endocrinologists play a crucial role.