Condition

Cushing's Syndrome

Excess cortisol production by adrenal glands

472K
People Affected
70
Active Trials
28K
New Cases/Year
500
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Bilateral Adrenalectomy
98% Effectiveness• 95% Confidence• 60% Safety• 1 trials• 5K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

immediate

Duration

one-time procedure, lifelong medication

Response Rate

98%

Remission Rate

98%

Common Side Effects:

Surgical complications (bleeding, infection): 8%
Lifelong adrenal insufficiency: 100%
Nelson's Syndrome (for pituitary disease): 20%

Annual Cost of Care

Drug Cost

$1,500

Monitoring

$2,500

Side Effects

$1,000

Total Annual

$5,000

Cost-Effectiveness

GOOD

QALYs Gained

0.9

ICER

$80,000/QALY

Cost per Remission

$5,102

Cost per Responder

$5,102

Treatment Outcomes
Primary Outcomes
Urinary Free Cortisol (24-hour)500 mcg/24h
-95% (-475 mcg/24h)
Blood Pressure150/95 mmHg
-12% (-20/10 mmHg)
Hemoglobin A1c7.5%
-15% (-1.1%)
Body Weight100 kg
-15% (-15 kg)
Secondary Benefits
Quality of Life (CushingQoL score)CushingQoL score: 40/100
+25% (+10 points)
Depression Symptoms (BDI-II score)BDI-II score: 30/63
-30% (-9 points)
Fatigue Severity (FSS score)FSS score: 50/63
-20% (-10 points)
Common Side Effects
Surgical complications (bleeding, infection)
+8%
Lifelong adrenal insufficiency
+100%
Nelson's Syndrome (for pituitary disease)
+20%
2
Transsphenoidal Surgery
75% Effectiveness• 90% Confidence• 65% Safety• 1 trials• 15K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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Tylenol💊
Exercise🏃
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65
DangerousModerateSafe

Time to Effect

immediate

Duration

one-time procedure, lifelong follow-up

Response Rate

75%

Remission Rate

75%

Common Side Effects:

Transient diabetes insipidus: 25%
Hypopituitarism (requiring replacement): 15%
CSF leak: 3%
Hemorrhage/Infection: 0.5%

Annual Cost of Care

Drug Cost

$1,000

Monitoring

$3,000

Side Effects

$1,000

Total Annual

$5,000

Cost-Effectiveness

GOOD

QALYs Gained

1

ICER

$70,000/QALY

Cost per Remission

$6,667

Cost per Responder

$6,667

Treatment Outcomes
Primary Outcomes
Urinary Free Cortisol (UFC)250 µg/24h
-76% (-190 µg/24h)
Late-Night Salivary Cortisol (LNSC)400 ng/dL
-75% (-300 ng/dL)
Systolic Blood Pressure150 mmHg
-13.3% (-20 mmHg)
HbA1c7.5%
-13.3% (-1.0%)
Secondary Benefits
Body Weight90 kg
-11.1% (-10 kg)
Quality of Life (SF-36 Physical Component)SF-36 Physical Component Score: 40/100
+50% (+20 points)
Depression Severity (HAM-D)HAM-D score: 24/52
-58.3% (-14 points)
Common Side Effects
Transient diabetes insipidus
+25%
Hypopituitarism (requiring replacement)
+15%
CSF leak
+3%
3
Osilodrostat
55% Effectiveness• 90% Confidence• 55% Safety• 9 trials• 400 participants
HIGH EvidencePoor ValueDose: 2-30 mg twice daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

55%

Number Needed to Treat (NNT)

2.5

Number Needed to Harm (NNH)

3.5

Common Side Effects:

Adrenal insufficiency: 35%
Nausea/Fatigue: 25%
Hypokalemia: 25%
Peripheral edema: 15%
QT prolongation: 8%

Annual Cost of Care

Drug Cost

$140,000

Monitoring

$2,000

Side Effects

$1,500

Total Annual

$143,500

Cost-Effectiveness

POOR

QALYs Gained

0.5

ICER

$580,000/QALY

Cost per Remission

$260,909

Cost per Responder

$260,909

Treatment Outcomes
Primary Outcomes
24-hour Urinary Free Cortisol (UFC)300 µg/24h
-65% (-195 µg/24h)
Systolic Blood Pressure145 mmHg
-10% (-14.5 mmHg)
Diastolic Blood Pressure95 mmHg
-10% (-9.5 mmHg)
Body Mass Index (BMI)32 kg/m^2
-8% (-2.56 kg/m^2)
Secondary Benefits
HbA1c (Glycated Hemoglobin)7.5%
-10% (-0.75%)
CushingQoL Score (Quality of Life)CushingQoL score: 40/100
+25% (+10 points)
Fatigue Severity Scale (FSS)FSS score: 5.5/7
-20% (-1.1 points)
Common Side Effects
Adrenal insufficiency
+35%
Nausea/Fatigue
+25%
Hypokalemia
+25%

Clinical Trial Phases:

Phase 3Phase 4
4
Ketoconazole
60% Effectiveness• 85% Confidence• 60% Safety• 4 trials• 2K participants
MODERATE EvidenceGood ValueDose: 200-1200 mg/day, divided doses
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

60%

Remission Rate

60%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

15

Common Side Effects:

Hepatotoxicity (elevated LFTs): 15%
Nausea/Vomiting: 12%
Gynecomastia (men): 12%
Hypogonadism: 8%

Annual Cost of Care

Drug Cost

$2,000

Monitoring

$1,500

Side Effects

$500

Total Annual

$4,000

Cost-Effectiveness

GOOD

QALYs Gained

0.5

ICER

$75,000/QALY

Cost per Remission

$6,667

Cost per Responder

$6,667

Treatment Outcomes
Primary Outcomes
24-Hour Urinary Free Cortisol (UFC)500 mcg/24h
-75% (-375 mcg/24h)
Morning Serum Cortisol35 mcg/dL
-65% (-22.75 mcg/dL)
Systolic Blood Pressure155 mmHg
-12% (-18.6 mmHg)
HbA1c (Glycated Hemoglobin)7.8%
-15% (-1.17%)
Secondary Benefits
Body Mass Index (BMI)34 kg/m^2
-9% (-3.06 kg/m^2)
Cushing's Syndrome-specific Quality of Life (CushingQoL) ScoreCushingQoL Score: 40/100
+50% (+20 points)
Serum Triglycerides220 mg/dL
-25% (-55 mg/dL)
Common Side Effects
Hepatotoxicity (elevated LFTs)
+15%
Nausea/Vomiting
+12%
Gynecomastia (men)
+12%

Clinical Trial Phases:

Phase 4
5
Mifepristone
50% Effectiveness• 90% Confidence• 55% Safety• 10 trials• 500 participants
HIGH EvidencePoor ValueDose: 300-1200 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

6-12 weeks

Duration

lifetime

Response Rate

50%

Remission Rate

%

Number Needed to Treat (NNT)

3.5

Number Needed to Harm (NNH)

2.5

Common Side Effects:

Hypokalemia: 45%
Nausea/Fatigue: 35%
Hypertension: 25%
Peripheral edema: 25%
Endometrial thickening/bleeding: 25%

Annual Cost of Care

Drug Cost

$200,000

Monitoring

$2,000

Side Effects

$1,500

Total Annual

$203,500

Cost-Effectiveness

POOR

QALYs Gained

0.4

ICER

$600,000/QALY

Cost per Responder

$407,000

Treatment Outcomes
Primary Outcomes
HbA1c in patients with diabetes/hyperglycemia8.0%
-20% (-1.6%)
Diastolic Blood Pressure95 mmHg
-7% (-7 mmHg)
Clinical Global Impression - Severity (CGI-S)5/7 (markedly ill)
-30% (-1.5 points)
Body Weight90 kg
-5.5% (-5 kg)
Secondary Benefits
Cushing's Disease-Specific Quality of Life (CushingQoL)30/100 (poor quality of life)
+40% (+12 points)
Muscle Strength (30-second chair stand test)8 repetitions
+25% (+2 repetitions)
Depressive Symptoms (Beck Depression Inventory - BDI-II)BDI-II score: 25/63 (moderate to severe depression)
-28% (-7 points)
Common Side Effects
Hypokalemia
+45%
Nausea/Fatigue
+35%
Hypertension
+25%

Clinical Trial Phases:

Phase 3Phase 4
6
Pasireotide
25% Effectiveness• 90% Confidence• 55% Safety• 5 trials• 500 participants
HIGH EvidencePoor ValueDose: 600-900 mcg BID (injectable) or 10-40 mg IM every 28 days (LAR)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

25%

Remission Rate

25%

Number Needed to Treat (NNT)

4.5

Number Needed to Harm (NNH)

1.5

Common Side Effects:

Hyperglycemia (often leading to diabetes): 75%
Diarrhea/Nausea: 50%
Abdominal pain: 25%
Gallstones: 15%
Bradycardia: 8%

Annual Cost of Care

Drug Cost

$150,000

Monitoring

$2,500

Side Effects

$2,000

Total Annual

$154,500

Cost-Effectiveness

POOR

QALYs Gained

0.4

ICER

$550,000/QALY

Cost per Remission

$618,000

Cost per Responder

$618,000

Treatment Outcomes
Primary Outcomes
Urinary Free Cortisol (UFC)700 nmol/24h
-45% (-315 nmol/24h)
Systolic Blood Pressure145 mmHg
-7% (-10 mmHg)
Weight90 kg
-8% (-7.2 kg)
CushingQoL ScoreCushingQoL Score: 50/100
-30% (-15 points)
Secondary Benefits
HbA1c6.5%
+8% (+0.5% points)
Fasting Plasma Glucose120 mg/dL
+15% (+18 mg/dL)
Diastolic Blood Pressure95 mmHg
-5% (-5 mmHg)
Common Side Effects
Hyperglycemia (often leading to diabetes)
+75%
Diarrhea/Nausea
+50%
Abdominal pain
+25%

Clinical Trial Phases:

Phase 3Phase 4