Steroidogenesis inhibitors are recommended when surgery has failed or is otherwise inappropriate, when it has been refused by the patient, or while waiting for maximal radiation therapy to take effect. Several factors must be considered when initiating and maintaining steroidogenesis inhibition – this summary offers an example of the ‘titrate to normalization’ approach to therapy and compares the latter with ‘block and replace’, covering patient selection, ‘how’, monitoring and side effects.

Patients with active Cushing’s syndrome may be immunocompromised, and so require strict adherence to barrier methods to prevent infection with COVID-19. Clinical practice guidelines lay out the key principles of care of these patients during the pandemic, including algorithms for investigations and management of the syndrome.