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

The document reported a case of a 45-year-old woman with recurrent cyclic Cushing’s disease, whose symptoms improved with block and replace therapy using metyrapone and hydrocortisone. Despite initial surgical intervention and normalization of endocrine test results, the patient experienced a recurrence of symptoms such as limb numbness, hyperphagia, and weight gain, along with elevated cortisol levels. Metyrapone treatment at 2,000 mg/day, combined with hydrocortisone at 15 mg/day, successfully normalized urinary free cortisol levels and alleviated symptoms. The study concluded that this therapy could be effective for managing recurrent cyclic Cushing’s disease, particularly in cases with a very short cycle.