Which class of medications is used to treat Cushing syndrome when surgery isn’t possible?

• A. Steroidogenesis inhibitors
• B. Mifepristone blocks cortisol effects
• C. Dopamine agonists
• D. Beta blockers

Answer: (A)

When surgery isn’t possible to remove the cortisol source, the treatment goal is to lower the amount of cortisol in the body. The best option for this is steroidogenesis inhibitors. These drugs act on the adrenal enzymes that produce cortisol, so they reduce circulating cortisol levels and help control the symptoms of Cushing syndrome. Examples include medications that inhibit key enzymes in adrenal steroid synthesis, which can be used chronically or acutely depending on the situation and how well the patient tolerates them.

Mifepristone takes a different approach by blocking cortisol’s effects at its receptors rather than decreasing cortisol production, so cortisol levels stay high even as symptoms are mitigated. This makes it useful in certain scenarios, but it doesn’t address the excess hormone itself as effectively as steroidogenesis inhibitors when surgery is not an option.

Dopamine agonists can help some pituitary-driven cases by reducing ACTH secretion, but they aren’t universally effective across all Cushing presentations. Beta blockers may help with some symptoms but don’t tackle the underlying hypercortisolism.

So, lowering cortisol production directly with steroidogenesis inhibitors is the most appropriate medical strategy when surgery isn’t feasible.