{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T20:05:14Z","timestamp":1781640314514,"version":"3.54.5"},"reference-count":188,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The first-line treatment for Cushing's disease is transsphenoidal adenomectomy, which can be curative in a significant number of patients. The second-line options in cases of failed primary pituitary surgery include repeat surgery, medical therapy, and radiation. The role for medical therapy has expanded in the last decade, and options include pituitary-targeting drugs, steroid synthesis inhibitors, and glucocorticoid receptor antagonists. Bilateral adrenalectomy is a more aggressive approach, which may be necessary in cases of persistent hypercortisolism despite surgery, medical treatment, or radiation or when rapid normalization of cortisol is needed. We review the available treatment options for Cushing's disease, focusing on the second-line treatment options to consider after failed primary pituitary surgery.<\/jats:p>","DOI":"10.1093\/ejendo\/lvae110","type":"journal-article","created":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T18:18:03Z","timestamp":1726337883000},"page":"R37-R54","source":"Crossref","is-referenced-by-count":8,"title":["How to manage Cushing's disease after failed primary pituitary surgery"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6024-9236","authenticated-orcid":false,"given":"Nidhi","family":"Agrawal","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, New York University Langone Medical Center , New York, NY 10016 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrine A","family":"Urwyler","sequence":"additional","affiliation":[{"name":"Clinic of Endocrinology, Diabetes and Metabolism, Department of Clinical Research, University Hospital Basel , 4031 Basel ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonal","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, New York University Langone Medical Center , New York, NY 10016 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-0643","authenticated-orcid":false,"given":"Niki","family":"Karavitaki","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research, University of Birmingham , Birmingham, B15 2TT ,","place":["United Kingdom"]},{"name":"Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners , Birmingham, B15 1PJ ,","place":["United Kingdom"]},{"name":"Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation 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