CLINICAL TRIALS PROFILE FOR ACTHREL

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All Clinical Trials for ACTHREL

Trial ID	Title	Status	Sponsor	Phase	Start Date	Summary
NCT00756925 ↗	Gender and Neural Substrates of Stress and Craving	Completed	Medical University of South Carolina		2009-02-01	Cocaine dependence is an insidious disease underscored by a powerful proclivity to relapse despite an individual's ability to recognize the deleterious consequences of continued drug use. To date, there are only a limited number of treatments, and no FDA approved medications for the treatment of cocaine dependence. Attempts to find reliable and successful treatments for cocaine dependence may be marred by gender differences in brain chemistry, structure, and function that are manifested as drug craving and relapse. For example, cues, drug exposure, and stress promote relapse, yet females appear be more susceptible to stress induced relapse, while males may be more susceptible to cue induced relapse. Therefore identifying the neural substrates involved in processing the valence of internal and external stimuli may provide further insight into cocaine dependence and provide more effective therapeutic strategies aimed at preventing relapse. Corticotropin releasing hormone (CRH) is a pharmacological activator of the hypothalamic pituitary adrenal (HPA) axis, and has been implicated in stress induced drug relapse. Corticotropin releasing hormone receptors are located at extrahypothalamic brain nuclei that have been implicated in determining the significance of both internal (somatic) and external (environmental) stimuli. The primary directive of this pilot project is to utilize functional magnetic resonance imaging (fMRI) to identify possible brain nuclei associated with with stress induced drug craving in cocaine dependent females.
NCT01373372 ↗	Corticotropin Releasing Hormone (CRH) Responsiveness in Children With Functional Dyspepsia	Withdrawn	Children's Mercy Hospital Kansas City	N/A	2016-12-01	Chronic abdominal pain is the most common persistent pain condition in children and adolescents, affecting 10-15% of children at any given time. One of the most often diagnosed types of abdominal pain is functional dyspepsia (FD). FD is an abdominal pain or discomfort (e.g., nausea, bloating) in the upper abdomen that does not get better by going to the bathroom. For some people it appears that stress can make FD worse. In adults, stress can cause the release of a hormone called corticotropin releasing hormone (CRH). The release of CRH can cause abdominal pain by affecting how fast things move through a person's stomach and intestines. This makes the organs in the abdomen more sensitive to pain, causing tenderness of the inside lining of the stomach and intestines. Different people react differently when the body releases CRH. Some people have abdominal pain without feeling any stress or anxiety while other people who have a lot of stress or anxiety don't have any abdominal pain. Some people have neither stress, anxiety, or abdominal pain when CRH is released into the body. In order to see how the bodies of children with functional dyspepsia and those without functional dyspepsia react to CRH, we will do a CRH stimulation test. A CRH stimulation test is routinely done in endocrine patients. It is not routinely done for patients with functional dyspepsia or for patients who do not have functional dyspepsia. Part of the CRH stimulation test is giving a synthetic type of corticotropin, Acthrel® (brand name for Corticorelin), as injection. Acthrel® has been approved by the Food and Drug Administration (FDA) for use. The purpose of this research study is to see if there are differences in how the bodies of children with functional dyspepsia react to CRH versus children who don't have functional dyspepsia. Being in this study involves one clinic visit where an IV placed and a CRH stimulation test. In this test the child will be given an injection of CRH and then observed for one hour. During that hour the child will have five blood draws through the IV and will be asked questions about their anxiety and abdominal pain. This visit will take about 4 hours. The following things will happen: - Your child will be asked to come to the clinic between 8a.m. and 10a.m. fasting. This means your child will have had nothing to eat or drink for 8 hours before coming to the clinic. - If your child is a female ten years of age or older, or has started having periods, a urine pregnancy test will be done before receiving the CRH infusion. - You and your child will each be asked to complete a survey that measures your child's anxiety. - Your child will have a biofeedback session that will measure your child's stress. In a biofeedback session, sensors are placed on your child's fingers, wrists and forehead. These sensors are connected to a computer that monitors your child's heartbeat, skin temperature and electrical pulses on your child's skin. - Your child will have an IV inserted into a vein in his/her arm. Your child may have a cream put on their arm to help with the pain of the IV insertion. The IV will be used to inject the CRH and draw blood. If the IV stops working and blood samples can no longer be drawn from it, your child may have another IV started or blood samples may be drawn by needle stick. - Your child will then have 30 minutes to relax. - Your child will then have CRH infused through the IV over one minute. - Your child will have blood drawn through the IV five times; right before the CRH stimulation test begins and 15, 30, 45 and 60 minutes after the CRH infusion. The total amount of blood drawn for the study will be about 2 ½ tablespoons. - Your child will be asked about their abdominal pain, nausea, bloating, stress and anxiety at three separate times during the 60 minutes. - Your child's heart rate will be measured throughout the CRH stimulation test.
NCT01459237 ↗	Effects of Hormone Stimulation on Brain Scans for Cushing s Disease	Completed	National Institute of Neurological Disorders and Stroke (NINDS)	Early Phase 1	2011-10-11	Background: - Cushing s disease can be caused by a tumor of the pituitary gland, a small gland about the size of a pea located at the base of the brain. These tumors produce high levels of hormones, which cause obesity, diabetes, and growth problems. The cure for this type of Cushing s disease is to have surgery that removes the tumor but leaves the pituitary gland alone. Currently, magnetic resonance imaging scans are the best way to find these tumors. However, many of these tumors do not show up on the scan. - Positron emission tomography (PET) scans use radioactive chemicals to light up parts of the body that are more active, such as tumors. Researchers want to try to make the small Cushing s disease tumors more active to help them show up on the scans. A special hormone will be given before the scan to make the tumors more active. Objectives: - To test the use of hormone stimulation to improve brain scans for Cushing s disease tumors. Eligibility: - Individuals at least 8 years of age who will be having surgery to remove Cushing s disease tumors. Design: - Participants will be screened with a medical history, physical exam, blood and urine tests, and imaging studies. - They will have three brain scans before surgery. The first scan is a magnetic resonance imaging scan to show a full picture of the brain. The second and third scans are PET scans. - The first PET scan will be given without the special hormone. The second PET scan will be done more than 24 hours but less than 14 days after the first PET scan. The second PET scan will be given with the special hormone. - Participants will have tumor removal surgery through another study protocol.
NCT01673087 ↗	Stress Biomarkers:Attaching Biological Meaning to Field Friendly Salivary Measures	Completed	University of Michigan	Phase 1	2012-10-01	Cortisol is a stress hormone that can be measured in saliva. This has provided a convenient way to evaluate the biological impact of day-to-day stressors that people encounter as they go about their lives, since saliva is so easy to collect. However, the biological meaning of saliva cortisol measures has never been carefully examined. The goal of this study is to collect saliva from a large group of people as they go about their every-day lives, to measure their cortisol levels, and then study them in the laboratory where Investigators can learn more about how their stress response system (which produces cortisol) is really functioning. Investigators can then determine much more precisely what saliva cortisol levels really mean in terms of stress system biology. This will allow investigators to obtain much more useful information from the next decade of research on naturalistic stress and its biological impact using saliva cortisol measures, helping investigators to understand how stress undermines health and how to combat this effect.
NCT03142893 ↗	Hormonal Mechanisms of Sleep Restriction - Axis Study	Active, not recruiting	Los Angeles Biomedical Research Institute	Phase 1	2017-05-08	The purpose of this study is to 1) determine how hypothalamic-pituitary-adrenal axis (HPA axis) activation occurs with sleep restriction 2) evaluate how hypothalamic-pituitary-gonadal axis (HPG axis) deactivation occurs with sleep restriction. The investigator will also examine the cognitive function associated with sleep restriction, including food intake and food cravings.

Clinical Trial Conditions for ACTHREL

Condition Name

Condition Name for ACTHREL
Intervention	Trials
Sleep Restriction	2
Cocaine Dependence	1
Cushing's Disease	1
Functional Dyspepsia	1

Condition MeSH

Condition MeSH for ACTHREL
Intervention	Trials
Pituitary Neoplasms	2
Pituitary Diseases	2
Gastritis	1
Dyspepsia	1

Clinical Trial Locations for ACTHREL

Trials by Country

Trials by Country for ACTHREL
Location	Trials
United States	7

Trials by US State

Trials by US State for ACTHREL
Location	Trials
California	2
Maryland	2
Michigan	1
Missouri	1
South Carolina	1

Clinical Trial Progress for ACTHREL

Clinical Trial Phase

Clinical Trial Phase for ACTHREL
Clinical Trial Phase	Trials
Phase 1	2
N/A	2
Early Phase 1	2

Clinical Trial Status

Clinical Trial Status for ACTHREL
Clinical Trial Phase	Trials
Completed	3
Active, not recruiting	1
Withdrawn	1

Clinical Trial Sponsors for ACTHREL

Sponsor Name

Sponsor Name for ACTHREL
Sponsor	Trials
National Institute of Neurological Disorders and Stroke (NINDS)	2
Los Angeles Biomedical Research Institute	2
Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center	2

Sponsor Type

Sponsor Type for ACTHREL
Sponsor	Trials
Other	7
NIH	2

Acthrel Clinical Trials, Market Analysis, Patent Status and Commercial Projection

Last updated: July 31, 2026

Acthrel, the trade name for corticorelin ovine triflutate, is an FDA-approved diagnostic peptide used to distinguish pituitary-dependent from ectopic ACTH-dependent Cushing syndrome. Its clinical development is mature rather than active. No meaningful late-stage trial program, biosimilar program, generic competition, or commercial growth platform is evident. Acthrel’s addressable market is limited by low disease prevalence, specialist use, competing diagnostic methods, and uncertain product availability. Its forward market outlook is therefore best characterized as flat to declining, with potential value concentrated in diagnostic supply continuity rather than revenue growth.

What is Acthrel and what is it used for?

Acthrel is an injectable formulation of corticorelin ovine triflutate, a synthetic form of ovine corticotropin-releasing factor. It stimulates ACTH release from pituitary corticotroph cells. Clinicians can use the ACTH response to help differentiate pituitary ACTH secretion from ectopic ACTH secretion in patients with ACTH-dependent Cushing syndrome.

The product received FDA approval under New Drug Application 20-911. Its labeled use is diagnostic, not therapeutic. Acthrel does not treat hypercortisolism, pituitary tumors, ectopic ACTH-producing tumors, or adrenal disease. The product is administered intravenously under medical supervision, with ACTH and cortisol measured before and after dosing (U.S. Food and Drug Administration [FDA], 1999).

Acthrel product profile

Attribute	Acthrel
Active ingredient	Corticorelin ovine triflutate
Therapeutic category	Diagnostic endocrine agent
Primary clinical use	Differential diagnosis of ACTH-dependent Cushing syndrome
Dosage form	Intravenous injection
FDA pathway	NDA approval
FDA approval	1999
Disease area	Endocrinology
Product type	Peptide diagnostic
Therapeutic role	Diagnostic stimulation test
Principal alternatives	Inferior petrosal sinus sampling, high-dose dexamethasone testing, corticotropin-releasing hormone testing, imaging and biochemical evaluation

What is the FDA regulatory status of Acthrel?

Acthrel was approved by the FDA, but its current commercial status must be distinguished from its historical approval. FDA records identify discontinued or withdrawn commercial products separately from products that were withdrawn for safety or efficacy reasons. A product can remain associated with an approved NDA while no longer being commercially supplied.

The Acthrel label established its diagnostic indication and dosing framework. Later clinical practice has relied on a broader diagnostic algorithm that includes late-night salivary cortisol, 24-hour urinary free cortisol, dexamethasone suppression testing, plasma ACTH, imaging, and selected invasive testing. The product’s narrow use and limited availability have reduced its role in routine endocrine practice.

FDA regulatory milestones

Date	Milestone
1999	FDA approval of Acthrel under NDA 20-911
Post-approval period	Use established as an adjunctive test for ACTH-dependent Cushing syndrome
Later commercial period	Product availability became limited relative to broader endocrine testing options
Current strategic status	Mature diagnostic product with limited evidence of active clinical expansion

The FDA label remains the primary source for the approved indication, dosing, contraindications, warnings, and pharmacology. FDA approval should not be interpreted as evidence of current market availability or active commercial promotion (FDA, 1999; FDA, n.d.-a).

Are there active clinical trials for Acthrel?

Acthrel does not have a conventional active clinical development program. Its pivotal development occurred before the modern registration-trial environment and was directed toward diagnostic performance rather than treatment outcomes.

Public trial registries and the published endocrine literature do not indicate a material pipeline of Phase 2 or Phase 3 trials designed to expand Acthrel into new indications. Research involving corticotropin-releasing hormone may continue in endocrinology, but that activity should not be treated as an Acthrel-sponsored development program.

Clinical development assessment

Development area	Current assessment
New therapeutic indications	No established program
Cushing syndrome diagnosis	Historical clinical use
Pediatric expansion	No material current program identified
Oncology applications	No established Acthrel program
Combination testing	Limited to investigator-led or historical diagnostic practice
Phase 3 registration activity	No meaningful active program
Post-marketing expansion	No visible commercial expansion strategy

The clinical value proposition is diagnostic discrimination. That limits trial opportunities because the product is not intended to improve symptoms, reduce mortality, or alter tumor control. A new trial would need to show better diagnostic accuracy, better patient selection, or a clinically meaningful reduction in invasive procedures compared with current endocrine testing.

What patents protect Acthrel and corticorelin ovine triflutate?

Acthrel’s principal commercial protection was historically tied to the composition, formulation, manufacturing, and regulatory exclusivity associated with corticorelin ovine triflutate. Any early patent estate would be expected to have reached the end of its enforceable life given the 1999 FDA approval date and the age of the product.

No current patent position appears capable of creating a durable market monopoly comparable to a recently launched drug. The relevant questions are whether any unexpired U.S. patent claims cover the exact peptide, dosage form, manufacturing process, or a specific diagnostic method, and whether those claims are listed in the FDA Orange Book.

Orange Book and generic-entry implications

The Orange Book generally lists patents and regulatory exclusivity for approved drug products where applicable. A mature injectable diagnostic with no evident active patent dispute has limited exposure to a new Paragraph IV challenge. A potential competitor would more likely rely on:

• A 505(b)(2) application using published safety and pharmacology information.
• A pharmaceutical equivalent or alternative injectable presentation.
• A compounded or hospital-prepared diagnostic substitute, subject to applicable law.
• A different diagnostic method that avoids the product altogether.

The absence of a visible active patent dispute does not establish that every historical patent has expired. It does indicate that patent litigation is not the principal commercial barrier. Manufacturing know-how, peptide quality control, sterile injectable production, regulatory economics, and reliable supply are more relevant barriers.

When does Acthrel lose exclusivity?

Acthrel’s practical exclusivity has already expired. The product was approved in 1999, placing it well beyond the standard five-year new chemical entity exclusivity period and beyond ordinary patent terms associated with pre-approval filings.

Exclusivity timeline

Protection category	Approximate status
New chemical entity exclusivity	Expired years ago
Orphan-drug exclusivity	Not the principal basis of Acthrel’s commercial position
Pediatric exclusivity	No material current impact
Original patent term	Expected to have expired or become commercially immaterial
Orange Book blocking position	No evident current blocking estate
Regulatory barrier	Potentially more important than patent exclusivity

Acthrel’s commercial risk is not a pending loss of exclusivity. It is whether a manufacturer has sufficient incentive to maintain supply for a small diagnostic market.

What patent litigation affects Acthrel?

No major ongoing patent litigation involving Acthrel is prominent in the public pharmaceutical litigation record. There is no widely reported Paragraph IV campaign comparable to those involving high-revenue oncology, immunology, diabetes, or cardiovascular products.

A litigation event would be economically unusual unless it involved one of three issues:

1. A new formulation or manufacturing process.
2. A successor product using corticorelin or a related peptide.
3. A competing diagnostic product seeking to preserve market access through a narrow method-of-use patent.

The absence of litigation reduces legal uncertainty but does not create a growth opportunity. It confirms that Acthrel is primarily a supply and market-access case rather than a patent-defense case.

What generic entry risks exist for Acthrel?

Generic or follow-on entry risk is structurally high because Acthrel is an old, single-ingredient injectable diagnostic with limited remaining exclusivity. Commercial entry remains difficult because the market is small and clinical demand is intermittent.

Potential entry pathways

Entry pathway	Risk level	Commercial rationale
Conventional generic injection	High legal feasibility, low commercial probability	Limited volume may not support development
505(b)(2) injection	Moderate	Could rely on existing literature and FDA data
Hospital compounding	Moderate operational substitute	May face quality, sterility and supply constraints
Alternative diagnostic test	High clinical substitution risk	Existing endocrine algorithms reduce dependence on Acthrel
Biosimilar pathway	Not applicable	Acthrel is a peptide drug, not a biologic approved through the biosimilar pathway

The biosimilar category is not the correct framework for Acthrel. A follow-on applicant would more likely pursue an abbreviated or hybrid drug application, depending on the reference product, formulation, manufacturing process, and FDA requirements.

How strong is the Acthrel patent estate?

The current patent estate is weak as a commercial defense. Its age, narrow indication, mature regulatory history, and limited evidence of active patent enforcement reduce the probability that patents alone can protect meaningful pricing power.

Patent-strength assessment

Factor	Assessment
Composition-of-matter protection	Historically important, now aged
Formulation protection	Potentially relevant but unlikely to create broad current exclusivity
Method-of-use claims	Narrow and vulnerable to diagnostic-method designarounds
Manufacturing claims	Could protect process know-how, but usually does not prevent alternative manufacturing
Orange Book leverage	Limited evidence of current blocking value
Litigation deterrence	Low
Residual commercial moat	Supply reliability, regulatory execution and clinician familiarity

For investors or licensors, the value of Acthrel would not normally be justified by a long-dated patent forecast. The relevant diligence would focus on product availability, FDA manufacturing compliance, clinical acceptance, reimbursement, and the economics of sterile peptide production.

What is the market size and revenue outlook for Acthrel?

Acthrel does not have a transparent, independently reported market comparable to blockbuster prescription drugs. Public company filings generally do not provide product-level revenue detail for a niche diagnostic peptide. As a result, a precise market-size estimate would not be reliable.

The addressable population is constrained by:

• The relatively low incidence of Cushing syndrome.
• The smaller subset with ACTH-dependent disease.
• The use of multiple diagnostic methods.
• The availability of invasive and biochemical alternatives.
• Limited need for repeated dosing.
• Specialist concentration in tertiary endocrine centers.

Market projection

Period	Base-case outlook	Primary driver
2024-2026	Flat to declining	Mature demand and substitution by alternative testing
2027-2029	Low, unstable demand	Supply continuity and specialist use
2030 onward	Niche or commercially inactive	Potential discontinuation, replacement or limited institutional use

A reasonable scenario framework is more useful than a point estimate:

Scenario	Market outcome
Upside	A reliable manufacturer restores supply, guidelines preserve a role for CRH stimulation testing, and tertiary centers maintain use
Base case	Demand remains low and fragmented, with no meaningful revenue growth
Downside	Product discontinuation or persistent shortages accelerate substitution by other diagnostic approaches

The market has low volume, low repeat utilization, and limited ability to support substantial promotional investment. Even a supply restoration would more likely produce a small specialty-diagnostic franchise than a scalable endocrine platform.

Which companies are challenging Acthrel?

No prominent branded company is publicly identified as pursuing a direct Acthrel challenge. Competitive pressure comes mainly from diagnostic substitutes rather than named generic manufacturers.

Clinical and commercial substitutes

• Inferior petrosal sinus sampling for localization of pituitary ACTH secretion.
• Dexamethasone suppression testing.
• Corticotropin-releasing hormone testing using alternative products or institutional protocols.
• Biochemical cortisol testing.
• Pituitary and ectopic-source imaging.
• Multimodal endocrine evaluation without Acthrel.

Inferior petrosal sinus sampling is invasive but can provide localization information that a systemic stimulation test cannot. Dexamethasone-based approaches are more familiar in many diagnostic algorithms. Imaging is not a direct substitute for biochemical stimulation, but it influences the decision to use or avoid Acthrel.

What generic launch scenarios are realistic for Acthrel?

The most realistic launch scenario is a low-volume 505(b)(2) or generic injectable introduced after a sponsor confirms reference-product availability, FDA requirements, manufacturing feasibility, and commercial demand.

Launch scenario analysis

Scenario	Timing logic	Market effect
Direct generic launch	Requires viable reference and manufacturing plan	May stabilize supply but capture limited revenue
505(b)(2) launch	Could leverage literature and established clinical use	Potentially faster than full clinical redevelopment
New CRH diagnostic formulation	Requires product development and validation	Could displace Acthrel rather than expand the market
No entrant	Most likely if economics remain unattractive	Continued reliance on alternative testing

The principal barrier is not an unexpired patent. It is the cost of developing and maintaining a sterile injectable for a narrow indication with uncertain annual demand.

How does Acthrel compare with competing endocrine diagnostics?

Criterion	Acthrel	Inferior petrosal sinus sampling	Dexamethasone suppression testing
Primary purpose	Stimulate ACTH response	Localize pituitary ACTH source	Assess cortisol suppression
Invasiveness	Low, intravenous administration	High, catheter-based procedure	Low
Setting	Specialty endocrine center	Specialized interventional center	Broad clinical use
Repeatability	Limited by availability and clinical need	Limited by invasiveness	Relatively practical
Regulatory complexity	Approved drug product	Procedure-based	Uses established drug/testing protocols
Commercial scale	Very small	Procedure market	Larger diagnostic utilization
Main limitation	Supply and narrow demand	Invasive and technically demanding	Imperfect specificity

Acthrel’s clinical niche is strongest when clinicians need a pharmacologic ACTH stimulation response and want to avoid or complement invasive localization procedures. Its commercial niche is weaker because diagnostic pathways can often proceed without it.

What licensing deals affect Acthrel?

No major current licensing transaction is publicly associated with Acthrel that materially changes its commercial outlook. Historical commercialization may have involved manufacturer, distributor or rights-holder arrangements, but those arrangements do not create a current growth thesis without evidence of active supply and promotion.

A viable licensing opportunity would require rights to the approved product or a new formulation, access to validated manufacturing, and a commercial plan focused on endocrine referral centers. The transaction would be more likely to involve a small asset purchase or supply agreement than a large strategic pharmaceutical partnership.

Key Takeaways

• Acthrel is corticorelin ovine triflutate, an FDA-approved diagnostic peptide for ACTH-dependent Cushing syndrome.
• Its FDA approval dates to 1999, and its original regulatory and patent exclusivity has expired.
• No material active clinical-trial program or major new indication strategy is evident.
• Biosimilar risk is not applicable because Acthrel is not a biologic marketed under the biosimilar framework.
• Generic and 505(b)(2) entry is legally plausible but commercially difficult because demand is small.
• No major current Paragraph IV campaign or patent litigation defines the asset.
• Alternative endocrine diagnostics create substantial substitution pressure.
• The base-case market outlook is flat to declining, with value driven by supply continuity rather than demand expansion.
• Acthrel’s residual strategic value lies in regulatory ownership, manufacturing capability and dependable access to a niche diagnostic market.

FAQs About Acthrel Clinical Trials and Market Status

Is Acthrel still available in the United States?

Availability has been limited relative to the product’s historical FDA approval. FDA approval status and commercial supply status are separate issues, so procurement depends on current manufacturer and distributor activity.

Does Acthrel have orphan-drug exclusivity?

Orphan-drug exclusivity is not the principal current protection for Acthrel. Any historical exclusivity associated with the product would not provide a meaningful present-day market barrier.

Can a company file an ANDA for Acthrel?

A follow-on applicant could evaluate an ANDA or 505(b)(2) pathway, depending on the reference product, dosage form, formulation, quality attributes and FDA requirements. The small market may make development economics unattractive.

Is corticorelin the same as corticotropin?

No. Corticotropin is ACTH, while corticorelin is a corticotropin-releasing hormone that stimulates endogenous ACTH release. They have different pharmacology and clinical uses.

What is the main commercial threat to Acthrel?

The principal threat is diagnostic substitution. Clinicians can use biochemical testing, dexamethasone suppression testing, imaging and inferior petrosal sinus sampling, reducing dependence on a dedicated corticorelin injection.

References

1. U.S. Food and Drug Administration. (1999). Acthrel (corticorelin ovine triflutate) injection prescribing information. FDA.

2. U.S. Food and Drug Administration. (n.d.-a). Drugs@FDA: FDA-approved drugs. FDA. https://www.accessdata.fda.gov/scripts/cder/daf/

3. U.S. Food and Drug Administration. (n.d.-b). Orange Book: Approved drug products with therapeutic equivalence evaluations. FDA. https://www.accessdata.fda.gov/scripts/cder/ob/

4. National Library of Medicine. (n.d.). ClinicalTrials.gov. U.S. National Library of Medicine. https://clinicaltrials.gov/

5. Fleseriu, M., Auchus, R., Bancos, I., Ben-Shlomo, A., Bertherat, J., Biermasz, N. R., Boguszewski, C. L., Bronstein, M. D., Buchfelder, M., Carmichael, J. D., et al. (2021). Consensus on diagnosis and management of Cushing’s disease: A guideline update. The Lancet Diabetes & Endocrinology, 9(12), 847-875.