<prompt> The treatment of choice in Cushings disease isOpen adrenalectomyBilateral adrenalectomyMedical managementTranssphenoidal excision of the pituitary adenoma  <response>: The treatment of choice in Cushings disease is transsphenoidal excision of the pituitary adenoma, which is successful in 80 of patients. Pituitary irradiation has been used for patients with persistent or recurrent disease after surgery. However, it is associated with a high rate of panhypopituitarism, and some patients develop visual deficits. This has led to increased use of stereotactic radiosurgery, which uses CT guidance to deliver high doses of radiotherapy to the tumour photon or gamma knife and also bilateral laparoscopic adrenalectomy. Patients who fail to respond to either treatment are candidates for pharmacologic therapy with adrenal inhibitors medical adrenalectomy such as ketoconazole, metyrapone, or aminoglutethimide 