A patient with Cushing's disease (pituitary ACTH-producing adenoma) has failed transsphenoidal surgery. According to current management guidelines, which medical therapy acts via a pituitary-level mechanism?

• A Metyrapone
• B Ketoconazole
• C Mifepristone
• D Pasireotide ✓

Explanation

Pasireotide is a multireceptor-targeted somatostatin analogue (SST1, SST2, SST3, SST5) that acts at the corticotroph adenoma to suppress ACTH secretion — the only approved pituitary-level therapy for Cushing's disease. Metyrapone and ketoconazole are adrenal steroidogenesis inhibitors acting peripherally. Mifepristone is a glucocorticoid receptor antagonist and does not lower ACTH or cortisol levels.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.