Block and Replace Therapy Successfully Improved Symptoms in Recurrent Cyclic Cushing's Disease

The study reported on a 45-year-old woman with recurrent cyclic Cushing’s disease, whose symptoms improved with block and replace therapy using metyrapone and hydrocortisone. Initially, the patient exhibited symptoms such as edema, hyperphagia, weight gain, hair loss, and limb numbness, with elevated ACTH and cortisol levels. After transsphenoidal surgery confirmed an ACTH-producing pituitary adenoma, her symptoms were temporarily alleviated. However, symptoms recurred, and metyrapone treatment was initiated. The therapy successfully normalized urinary free cortisol levels and improved symptoms, suggesting that block and replace therapy could be effective for managing recurrent cyclic Cushing’s disease, particularly in cases with short cycles.