Pasireotide, a multiligand somatostatin analog is the first pituitary-directed agent shown to effectively reduce cortisol levels and improve disease symptoms in a large, prospective, phase 3 clinical trial. Further investigation is needed, however, to clarify optimal management approaches for pasireotide-associated hyperglycemia. The dopamine agonist cabergoline has shown some promise in a small, open-label trial (and one retrospective trial), but randomized, controlled trials with this agent have not been conducted. A combination of lower doses of pasireotide with dopamine agonists or adrenal steroidogenesis inhibitors (e.g., a combination of low-dose pasireotide/cabergoline/ketoconazole) may increase the proportion of patients whose disease can be controlled while minimizing adverse effects.