The rationale for the treatment of Cushing's disease is to normalize serum cortisol and ACTH levels, while preserving the anterior pituitary function. The treatment of choice for Cushing's disease is surgery. However, in some circumstances the patients can need further treatment modalities including reoperation, radiotherapy and medical therapy. The medical therapy for Cushing's disease is preferred in order to decrease the excessive cortisol levels prior to surgery, to decrease the

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... s or to control hypercortisolaemia while awaiting the full effect of radiotherapy or of the treatment of metastatic disease. Between the two groups of drugs-steroidogenesis inhibitors and centrally acting drugs-steroidogenesis inhibitors, particularly metyrapone and ketoconazole, are the preferred agents. Centrally acting drugs may be superior to steroidogenesis inhibitors in the treatment of Cushing's disease by decreasing the adrenocorticothrophic hormone (ACTH) levels and inhibiting the tumor growth. In this review we are aimed to evaluate the possible use of peroxisome proliferator-activated receptor-gamma agonists as centrally acting drugs in the treatment of Cushing's disease. Turk Jem 2009; 13: 80-3 Özet Cushing hastal›¤›n›n tedavisinde amaç, kortizol ve adrenokortikotropik hormon (ACTH) düzeylerini normale getirmek ve ön hipofiz fonksiyon-lar›n› korumakt›r. Cushing hastal›¤›nda ilk seçilecek tedavi cerrahidir; fakat baz› hastalarda ikinci cerrahi, radyoterapi ve medikal tedavi gereke-bilmektedir. Medikal tedavi; cerrahi öncesi kortizol düzeylerini normale getirmek, radyoterapinin etki etmesinin beklendi¤i dönemde hiperko-rtizolemiyi kontrol alt›nda tutmak ve metastatik hastal›¤›n tedavisinde kullan›lmaktad›r. Medikal tedavide iki grup ilaç vard›r: steroidogenez inhibitörleri ve santral etkili ilaçlar. Tedavide steroidogenez inhibitörleri daha etkili oldu¤u için özellikle metirapon ve ketokanazol tercih edilmektedir. Santral etkili ilaçlar ise ACTH düzeylerinde düflüfl sa¤lama ve tümör büyümesini kontrol alt›na alma gibi etkilerle steroidogenez inhibitörlerine üstünlük sa¤layabilir. Bu derlemede, santral etkili ilaçlardan peroxisome proliferatör aktive reseptör (PPAR) gamma agonist-lerinin Cushing hastal›¤› tedavisindeki yerini inceleyece¤iz. Türk Jem 2009; 13: 80-3