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Bavaresco A, Mazzeo P, Lazzara M, Barbot M. Adipose tissue in cortisol excess: What Cushing's syndrome can teach us? Biochem Pharmacol 2024; 223:116137. [PMID: 38494065 DOI: 10.1016/j.bcp.2024.116137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Endogenous Cushing's syndrome (CS) is a rare condition due to prolonged exposure to elevated circulating cortisol levels that features its typical phenotype characterised by moon face, proximal myopathy, easy bruising, hirsutism in females and a centripetal distribution of body fat. Given the direct and indirect effects of hypercortisolism, CS is a severe disease burdened by increased cardio-metabolic morbidity and mortality in which visceral adiposity plays a leading role. Although not commonly found in clinical setting, endogenous CS is definitely underestimated leading to delayed diagnosis with consequent increased rate of complications and reduced likelihood of their reversal after disease control. Most of all, CS is a unique model for systemic impairment induced by exogenous glucocorticoid therapy that is commonly prescribed for a number of chronic conditions in a relevant proportion of the worldwide population. In this review we aim to summarise on one side, the mechanisms behind visceral adiposity and lipid metabolism impairment in CS during active disease and after remission and on the other explore the potential role of cortisol in promoting adipose tissue accumulation.
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Affiliation(s)
- Alessandro Bavaresco
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Pierluigi Mazzeo
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Martina Lazzara
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy
| | - Mattia Barbot
- Department of Medicine DIMED, University of Padua, Padua, Italy; Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy.
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De Alcubierre D, Ferrari D, Mauro G, Isidori AM, Tomlinson JW, Pofi R. Glucocorticoids and cognitive function: a walkthrough in endogenous and exogenous alterations. J Endocrinol Invest 2023; 46:1961-1982. [PMID: 37058223 PMCID: PMC10514174 DOI: 10.1007/s40618-023-02091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE The hypothalamic-pituitary-adrenal (HPA) axis exerts many actions on the central nervous system (CNS) aside from stress regulation. Glucocorticoids (GCs) play an important role in affecting several cognitive functions through the effects on both glucocorticoid (GR) and mineralocorticoid receptors (MR). In this review, we aim to unravel the spectrum of cognitive dysfunction secondary to derangement of circulating levels of endogenous and exogenous glucocorticoids. METHODS All relevant human prospective and retrospective studies published up to 2022 in PubMed reporting information on HPA disorders, GCs, and cognition were included. RESULTS Cognitive impairment is commonly found in GC-related disorders. The main brain areas affected are the hippocampus and pre-frontal cortex, with memory being the most affected domain. Disease duration, circadian rhythm disruption, circulating GCs levels, and unbalanced MR/GR activation are all risk factors for cognitive decline in these patients, albeit with conflicting data among different conditions. Lack of normalization of cognitive dysfunction after treatment is potentially attributable to GC-dependent structural brain alterations, which can persist even after long-term remission. CONCLUSION The recognition of cognitive deficits in patients with GC-related disorders is challenging, often delayed, or mistaken. Prompt recognition and treatment of underlying disease may be important to avoid a long-lasting impact on GC-sensitive areas of the brain. However, the resolution of hormonal imbalance is not always followed by complete recovery, suggesting irreversible adverse effects on the CNS, for which there are no specific treatments. Further studies are needed to find the mechanisms involved, which may eventually be targeted for treatment strategies.
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Affiliation(s)
- D De Alcubierre
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Ferrari
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Mauro
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - J W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK
| | - R Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK.
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Savas M, Mehta S, Agrawal N, van Rossum EFC, Feelders RA. Approach to the Patient: Diagnosis of Cushing Syndrome. J Clin Endocrinol Metab 2022; 107:3162-3174. [PMID: 36036941 PMCID: PMC9681610 DOI: 10.1210/clinem/dgac492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Indexed: 12/27/2022]
Abstract
Cushing syndrome results from supraphysiological exposure to glucocorticoids and is associated with significant morbidity and mortality. The pathogenesis includes administration of corticosteroids (exogenous Cushing syndrome) or autonomous cortisol overproduction, whether or not ACTH-dependent (endogenous Cushing syndrome). An early diagnosis of Cushing syndrome is warranted; however, in clinical practice, it is very challenging partly because of resemblance with other common conditions (ie, pseudo-Cushing syndrome). Initial workup should start with excluding local and systemic corticosteroid use. First-line screening tests including the 1-mg dexamethasone suppression test, 24-hour urinary free cortisol excretion, and late-night salivary cortisol measurement should be performed to screen for endogenous Cushing syndrome. Scalp-hair cortisol/cortisone analysis helps in the assessment of long-term glucocorticoid exposure as well as in detection of transient periods of hypercortisolism as observed in cyclical Cushing syndrome. Interpretation of results can be difficult because of individual patient characteristics and hence requires awareness of test limitations. Once endogenous Cushing syndrome is established, measurement of plasma ACTH concentrations differentiates between ACTH-dependent (80%-85%) or ACTH-independent (15%-20%) causes. Further assessment with different imaging modalities and dynamic biochemical testing including bilateral inferior petrosal sinus sampling helps further pinpoint the cause of Cushing's syndrome. In this issue of "Approach to the patient," the diagnostic workup of Cushing syndrome is discussed with answering the questions when to screen, how to screen, and how to differentiate the different causes. In this respect, the latest developments in biochemical and imaging techniques are discussed as well.
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Affiliation(s)
| | | | - Nidhi Agrawal
- Division of Endocrinology, NYU Langone Medical Center/ Bellevue Hospital Center, New York, NY
| | - Elisabeth F C van Rossum
- Correspondence: Elisabeth F.C. van Rossum, MD, PhD, Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Richard A Feelders
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Fallo F, Di Dalmazi G, Beuschlein F, Biermasz NR, Castinetti F, Elenkova A, Fassnacht M, Isidori AM, Kastelan D, Korbonits M, Newell-Price J, Parati G, Petersenn S, Pivonello R, Ragnarsson O, Tabarin A, Theodoropoulou M, Tsagarakis S, Valassi E, Witek P, Reincke M. Diagnosis and management of hypertension in patients with Cushing's syndrome: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens 2022; 40:2085-2101. [PMID: 35950979 DOI: 10.1097/hjh.0000000000003252] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endogenous/exogenous Cushing's syndrome is characterized by a cluster of systemic manifestations of hypercortisolism, which cause increased cardiovascular risk. Its biological basis is glucocorticoid excess, acting on various pathogenic processes inducing cardiovascular damage. Hypertension is a common feature in Cushing's syndrome and may persist after normalizing hormone excess and discontinuing steroid therapy. In endogenous Cushing's syndrome, the earlier the diagnosis the sooner management can be employed to offset the deleterious effects of excess cortisol. Such management includes combined treatments directed against the underlying cause and tailored antihypertensive drugs aimed at controlling the consequences of glucocorticoid excess. Experts on endocrine hypertension and members of the Working Group on Endocrine Hypertension of the European Society of Hypertension (ESH) prepared this Consensus document, which summarizes the current knowledge in epidemiology, genetics, diagnosis, and treatment of hypertension in Cushing's syndrome.
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Affiliation(s)
- Francesco Fallo
- Clinica Medica 3, Department of Medicine, University of Padova, Padova
| | - Guido Di Dalmazi
- Unit of Endocrinology and Diabetes Prevention and Care, Department of Medical and Surgical Sciences, University of Bologna
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nienke R Biermasz
- Leiden University Medical Center and European Reference Center for Rare Endocrine Conditions (Endo-ERN), Leiden, Netherlands
| | - Frederic Castinetti
- Aix Marseille Université, Marseille Medical Genetics, INSERM
- Assistance Publique Hopitaux de Marseille
- Department of Endocrinology, La Conception Hospital, Marseille, France
| | - Atanaska Elenkova
- Department of Endocrinology, University Specialized Hospital for Active Treatment in Endocrinology (USHATE) "Acad. Ivan Penchev", Medical University - Sofia, Sofia, Bulgaria
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb University School of Medicine, Zagreb, Croatia
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
| | - John Newell-Price
- Department of Oncology and Metabolism, Medical School, University of Sheffield
- Department of Endocrinology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Stephan Petersenn
- ENDOC Center for Endocrine Tumors, Hamburg, Germany and University of Duisburg-Essen, Essen, Germany
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli
- Unesco Chair for Health Education and Sustainable Development, "Federico II" University, Naples, Italy
| | - Oskar Ragnarsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Antoine Tabarin
- CHU de Bordeaux, Hôpital Haut Lévêque, University of Bordeaux, Bordeaux, France
| | - Marily Theodoropoulou
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Elena Valassi
- Endocrinology Unit, Hospital Germans Trias i Pujol, Badalona
- Research Center for Pituitary Diseases (CIBERER Unit 747), Hospital Sant Pau, Barcelona, Spain
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Bródno Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
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Balomenaki M, Margaritopoulos D, Vassiliadi DA, Tsagarakis S. Diagnostic workup of Cushing's syndrome. J Neuroendocrinol 2022; 34:e13111. [PMID: 35979805 DOI: 10.1111/jne.13111] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Cushing's syndrome (CS) is a rare but detrimental endocrine disorder. Early diagnosis and prompt treatment are essential since the duration of hypercortisolism has an adverse impact on the extent of comorbidities and overall survival. The diagnostic approach involves a stepwise process that includes (1) screening and confirming the diagnosis and (2) establishing the aetiology of CS. The tests currently used to confirm the diagnosis of CS include urinary free cortisol measurements, the dexamethasone suppression test and late- night salivary cortisol or midnight serum cortisol measurements. None of these tests are ideal; all have pitfalls and require careful interpretation. Following confirmation of CS, measurement of ACTH discriminates between ACTH-dependent and non-ACTH dependent causes of CS. Adrenal imaging provides clues for the aetiology of non-ACTH dependent forms. Differentiation between the ACTH-dependent forms that involve pituitary corticotroph adenomas and ectopic ACTH sources is more complex and include pituitary MRI imaging, the high dose dexamethasone suppression test, the CRH test, bilateral inferior petrosal sinus sampling and, when required imaging modalities to detect ectopic ACTH secreting lesions. This review, which is part of a special issue on "Update of Cushing's syndrome: 100 years after Minnie G" will provide an update on our current diagnostic workup for the confirmation and differential diagnosis of CS.
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Affiliation(s)
- Maria Balomenaki
- Department of Endocrinology and Diabetes, Evangelismos Hospital, Athens, Greece
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Kimura Takiguchi M, Morimoto S, Watanabe D, Abe K, Ichihara A. Urinary free cortisol excretion is associated with lumbar bone density in patients with adrenal Cushing's syndrome. Hypertens Res 2022; 45:1632-1642. [PMID: 35595982 DOI: 10.1038/s41440-022-00939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022]
Abstract
Patients with adrenal Cushing's syndrome have a poor prognosis due to the autonomous hypersecretion of endogenous cortisol from the adrenal gland. Although several clinical examinations have been developed to manifest the autonomous hypersecretion of endogenous cortisol in this syndrome, it is unknown which parameter of cortisol overproduction is best associated with the adrenal cortisol content and bone and vascular complications of this syndrome. Therefore, the present study was undertaken to evaluate the parameter(s) associated with the adrenal cortisol content in patients with adrenal Cushing's syndrome, as well as to assess the associations between these parameters and the vascular and bone complications of this syndrome. Cardiovascular factors such as blood pressure and pulse rate, glucose metabolism, lipid metabolism, renal function, and indices of arteriosclerosis, except for diastolic blood pressure, failed to show an association with the adrenal cortisol content. Twenty-four-hour urinary free cortisol excretion (ρ = 0.893, P = 0.007) and plasma cortisol levels after the 1-mg (ρ = 0.857, P = 0.014) or 8-mg (ρ = 0.900, P = 0.037) overnight dexamethasone suppression test, but not plasma cortisol levels in the morning or late at night or indices of 131I-adosterol single-photon emission computed tomography-computed tomography, were significantly and positively associated with the adrenal cortisol content. Twenty-four-hour urinary free cortisol excretion, and not plasma cortisol levels after the 1- or 8-mg overnight dexamethasone suppression test, was significantly and negatively associated with lumbar spine bone density (lumbar spine bone mineral density, ρ = -0.786, P = 0.036; lumbar spine T score, ρ = -0.883, P = 0.009; and lumbar spine Z score, ρ = -0.883, P = 0.009). These results indicate that 24-h urinary free cortisol excretion is best associated with a decrease in bone density via increased adrenal cortisol overproduction and suggest that it could be used as a marker for osteoporosis in these patients.
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Affiliation(s)
- Miwa Kimura Takiguchi
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Morimoto
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan.
| | - Daisuke Watanabe
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Abe
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
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Paragliola RM, Corsello A, Papi G, Pontecorvi A, Corsello SM. Cushing's Syndrome Effects on the Thyroid. Int J Mol Sci 2021; 22:ijms22063131. [PMID: 33808529 PMCID: PMC8003177 DOI: 10.3390/ijms22063131] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 01/05/2023] Open
Abstract
The most known effects of endogenous Cushing’s syndrome are the phenotypic changes and metabolic consequences. However, hypercortisolism can exert important effects on other endocrine axes. The hypothalamus–pituitary–thyroid axis activity can be impaired by the inappropriate cortisol secretion, which determinates the clinical and biochemical features of the “central hypothyroidism”. These findings have been confirmed by several clinical studies, which also showed that the cure of hypercortisolism can determine the recovery of normal hypothalamus–pituitary–thyroid axis activity. During active Cushing’s syndrome, the “immunological tolerance” guaranteed by the hypercortisolism can mask, in predisposed patients, the development of autoimmune thyroid diseases, which increases in prevalence after the resolution of hypercortisolism. However, the immunological mechanism is not the only factor that contributes to this phenomenon, which probably includes also deiodinase-impaired activity. Cushing’s syndrome can also have an indirect impact on thyroid function, considering that some drugs used for the medical control of hypercortisolism are associated with alterations in the thyroid function test. These considerations suggest the utility to check the thyroid function in Cushing’s syndrome patients, both during the active disease and after its remission.
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Dallel S, Devoize L, Tauveron I, Pereira B, Clavelou P, Maqdasy S, Moisset X, Dallel R. Characteristics of pain in patients with pituitary adenomas: A cross-sectional study. Eur J Pain 2021; 25:913-923. [PMID: 33400298 DOI: 10.1002/ejp.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study determines the prevalence and particularities of headache and pain with neuropathic characteristics (NC) in a large French group of patients with pituitary adenoma (PA). METHODS Analysis of validated self-administered questionnaires, radiological characteristics and treatment strategies of PA was performed. RESULTS Of the 221 sent questionnaires, 146 could be used for statistical analysis, 50% of which were completed by women. Among responders, 58.9% had pain: 30.1% migraine, 15.7% pain with NC and 13.1% other types of pain. Migraine was more common in patients with PA than in the general population (30.1% vs. 21.3%, p = .010) and attacks received appropriate treatment for less than 20% of these patients. Furthermore, the prevalence of chronic migraine was much higher than in the general population (6.8% vs. 2.2%, p = .003). Neuropathic pain was also more frequent in PA patients than in the general population (15.8% vs. 6.9%, p < .001). Neuropathic pain was most often located in the extremities and was frequently described as an 'electric shock', 'numbness', or 'pins-and-needles'. Multivariate analyses linked migraine to younger age, anxiety, pain with NC, and a visible tumour on MRI, regardless of its invasiveness or secretory nature. CONCLUSIONS Migraine headaches and neuropathic pain are more frequent and disabling in PA patients than in the general population. Both types of pain are comorbid in PA patients and are poorly treated. Migraine is associated with the presence of a tumour. Thus, biological mechanisms of this relationship need to be characterized to design optimal treatments for these individuals. SIGNIFICANCE Migraine headaches and neuropathic pain are more common in PA patients than in the general population and are generally poorly treated. A systematic screening for migraine should be done by physicians in daily practice to provide adequate therapeutics.
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Affiliation(s)
- Sarah Dallel
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Laurent Devoize
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Igor Tauveron
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Bruno Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Pierre Clavelou
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Salwan Maqdasy
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Xavier Moisset
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Radhouane Dallel
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
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Kumar N, Jarial KDS, Bhansali A, Nehra R, Vyas S, Walia R. Neurocognitive Functions and Brain Volume in Patients with Endogenous Cushing's Syndrome Before and After Curative Surgery. Indian J Endocrinol Metab 2020; 24:396-401. [PMID: 33489843 PMCID: PMC7810051 DOI: 10.4103/ijem.ijem_162_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cushing's syndrome (CS) leads to various neuropsychiatric manifestations due to structural and functional changes of the brain and contributes significantly in the impairment of health-related quality of life. AIM AND OBJECTIVE This study is conducted with aims to evaluate neurocognitive functions and brain volume in patients with endogenous Cushing's syndrome before and after curative surgery. METHODS The diagnosis of CS was made by clinical features, abnormal cortisol dynamics, ACTH levels, and imaging studies. Neuropsychiatric tests (Beck depression Index, Spatial span test, PGI memory scale, Color trail test, Verbal fluency test), and Brain volume (Bi-caudate and third ventricular diameter) were done before and after curative surgery. RESULTS Fifteen patients of CS were included for the study; all patients underwent curative surgery, neuropsychiatric assessment, and brain volume measurements. Nine patients were followed successfully till remission and repeat evaluation of these patients was done. Depression was the most common neuropsychiatric illness. Severity of depression positively correlated with 0800 h plasma cortisol and ACTH. Patients with higher severity of depression had maximum improvement after curative surgery. Significant decrease in the third ventricular, as well as bicaudate diameter, was observed after curative surgery (P < 0.01). CONCLUSION Neuropsychiatric functions and structural brain changes reverse after curative surgery in patients with endogenous CS, however, long term follow-up is required to know whether these changes reverse completely or not.
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Affiliation(s)
- Nachimuthu Kumar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kush D. S. Jarial
- Department of Endocrinology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Vyas
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Araujo-Castro M, Pascual-Corrales E, Martínez San Millan JS, Rebolleda G, Pian H, Ruz-Caracuel I, De Los Santos Granados G, Ley Urzaiz L, Escobar-Morreale HF, Rodríguez Berrocal V. Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence. Endocrine 2020; 69:5-17. [PMID: 32170587 DOI: 10.1007/s12020-020-02247-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022]
Abstract
There is a lack of evidence on timing, frequency, and duration of postoperative endocrine, radiologic, and ophthalmologic assessments that should be performed after pituitary surgery (PS). However, it is known that careful optimization of treatment and follow-up strategies as well as a multidisciplinary approach may have a significant impact on long-term outcomes, improving surgical results, minimize complications and facilitate their correct treatment if occurring, and optimize the hormonal, ophthalmological, and radiological reassessment throughout the follow-up. Considering that there are no specific guidelines on the postoperative management of patients with pituitary tumors (PT), we present our protocol for the postoperative management of patients with PT. It has been elaborated by the multidisciplinary team of a Spanish Pituitary Tumor Center of Excellence (PTCE) that includes at least one neurosurgeon, ENT, neuroradiologist, neuro-ophthalmologist, endocrine pathologist and endocrinologist specialized in pituitary diseases. We elaborated this guideline with the aim of sharing our experience with other centers involved in the management of PT thereby facilitating the postoperative management of patients submitted to PS.
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Affiliation(s)
- M Araujo-Castro
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034, Madrid, Spain.
| | - E Pascual-Corrales
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J S Martínez San Millan
- Neuroradiology Unit, Department of Diagnostic Imaging, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G Rebolleda
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - H Pian
- Endocrinology Unit, Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - I Ruz-Caracuel
- Endocrinology Unit, Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G De Los Santos Granados
- Universidad de Alcalá, Madrid, Spain
- Rinology Unit, Department of Otorhinolaryngology (ENT), Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
| | - L Ley Urzaiz
- Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - H F Escobar-Morreale
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
- Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - V Rodríguez Berrocal
- Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Ramezani A, Zakeri A, Mard-Soltani M, Mohammadian A, Hashemi ZS, Mohammadpour H, Jahangiri A, Khalili S, Rasaee MJ. Structure Based Screening for Inhibitory Therapeutics of CTLA-4 Unveiled New Insights About Biology of ACTH. Int J Pept Res Ther 2020. [DOI: 10.1007/s10989-019-09891-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Mu MH, Wang YN, Huang Y, Niu XL, Chen HD, Gao XH, Qi RQ. Local hyperthermia cleared multifarious viral warts in a patient with Cushing's syndrome. Dermatol Ther 2019; 32:e12815. [PMID: 30633835 DOI: 10.1111/dth.12815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/27/2018] [Accepted: 01/05/2019] [Indexed: 12/22/2022]
Abstract
A female Cushing's syndrome patient had been suffering from extensive viral warts for months. She was diagnosed with flat warts, common warts and plantar warts. The plantar warts on her right foot were initially treated using local hyperthermia at 44°C for 30 min according to a defined protocol, followed by treatment targeting a common wart on her left thumb. In response to hyperthermia, the flat warts on her eyelid dissipated within 12 weeks, and when combined with a 1 week administration of imiquimod, the common warts and plantar warts completely disappeared within 8 weeks. There were no signs of recurrence and during this treatment her Cushing's syndrome was alleviated. This pioneer trial suggests that local hyperthermia may serve as an effective mean for treating multiple cutaneous warts under the conditions of a systemic immuno-compromised disease.
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Affiliation(s)
- Ming-Han Mu
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
| | - Yi-Ning Wang
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
| | - Yu Huang
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
| | - Xue-Li Niu
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
| | - Hong-Duo Chen
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
| | - Xing-Hua Gao
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
| | - Rui-Qun Qi
- Department of dermatology, NHC/Ministry of Education/Liaoning Province Key Laboratory of Immunodermatology (China Medical University) The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning, P.R. China
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Numakura K, Nara T, Kanda S, Saito M, Narita S, Inoue T, Habuchi T. Overweight Patients Less Improved Kidney Function After Laparoscopic Surgery for Adrenocortical Adenoma With Excess Cortisol Secretion. Front Endocrinol (Lausanne) 2019; 10:572. [PMID: 31481933 PMCID: PMC6710343 DOI: 10.3389/fendo.2019.00572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: Glucocorticoid (GC) is known to be involved in the deterioration of kidney function both directly by affecting the glomeruli and renal tubules and indirectly by affecting cardiovascular function. Autonomous GC secretion is the main feature of primary adrenal hypercortisolism (PAHC). However, the ideal treatment option (operation vs. medical treatment and observation) for patients with PAHC has not been established yet. In this study, we assessed a time series of kidney function in patients with PAHC treated via laparoscopic adrenalectomy and investigated the predictive factors for kidney function 1 year after surgery. Methods: From September 1997 to July 2017, 175 laparoscopic adrenalectomies were performed for adrenal tumors at Akita University. Thirty patients, who were diagnosed as having PAHC via preoperative endocrinological evaluations and followed up for at least 1 year after surgery, were included in this study. Patients with severe complications or simultaneous aldosteronism were excluded. The mean age of the 30 patients was 57.5 years (range, 33-79 years; males, 4; females, 26), and the right and left sides were affected in 9 and 21 patients, respectively. Results: In all, 18 patients were diagnosed as having Cushing's syndrome and 12 as having subclinical Cushing's syndrome. The steroid cover was required in all cases after surgery. The estimated glomerular filtration rate significantly improved (78.4 mL/min [64.8-95.8] vs. 84.1 mL/min [66.8-104.0], p = 0.012) 1 year after surgery. Patients showing 5% or more improvement in kidney function and those showing less than 5% improvement were compared. On performing univariate analyses, factors such as a longer operative time, heavy body mass index (BMI), and preoperative unsuppressed ACTH were associated with worse improvement in kidney function. No significant associations were observed regarding metabolic disorders, clinical symptoms, and gross proteinuria. On multivariate analysis, patients with a higher BMI (≥ 24 kg/m2) showed worse improvement in kidney function at 1 year after surgery (odds ratio 14.0, 95% confidence interval 1.3-142.9, p = 0.012). Conclusions: In PAHC patients, after 1 year of follow-up, kidney function improved in terms of estimated glomerular filtration rate. Therefore, this improvement seems to be delayed in overweight patients, suggesting its direct role in renal function.
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Pivonello R, De Martino MC, De Leo M, Simeoli C, Colao A. Cushing's disease: the burden of illness. Endocrine 2017; 56:10-18. [PMID: 27189147 DOI: 10.1007/s12020-016-0984-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 05/06/2016] [Indexed: 12/20/2022]
Abstract
Cushing's syndrome is caused by prolonged exposure to elevated cortisol levels. The most common form of endogenous Cushing's syndrome is Cushing's disease, which results from an adrenocorticotropic hormone-secreting pituitary tumour. Cushing's disease is associated with increased mortality, mostly attributable to cardiovascular complications, and a host of comorbidities such as metabolic and skeletal disorders, infections and neuropsychiatric disturbances. As a consequence, Cushing's disease substantially impairs health-related quality of life. It is crucial that the condition is diagnosed as early as possible, and that rapid and effective treatment is initiated in order to limit long-term morbidity and mortality. The initial treatment of choice for Cushing's disease is selective transsphenoidal pituitary surgery; however, the risk of recurrence after initial surgery is high and remains so for many decades after surgery. A particular concern is the growing body of evidence indicating that the negative physical and psychosocial sequelae of chronic hypercortisolism may persist in patients with Cushing's disease even after long-term surgical 'cure'. Current treatment options for post-surgical patients with persistent or recurrent Cushing's disease include second surgery, radiotherapy, bilateral adrenalectomy and medical therapy; however, each approach has its limitations and there is an unmet need for more efficacious treatments. The current review provides an overview of the burden of illness of Cushing's disease, underscoring the need for prompt diagnosis and effective treatment, as well as highlighting the need for better therapies.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Maria Cristina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini, 5, 80131, Naples, Italy
| | - Monica De Leo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini, 5, 80131, Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini, 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini, 5, 80131, Naples, Italy
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15
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de Araújo LJT, Lerario AM, de Castro M, Martins CS, Bronstein MD, Machado MC, Trarbach EB, Villares Fragoso MCB. Transcriptome Analysis Showed a Differential Signature between Invasive and Non-invasive Corticotrophinomas. Front Endocrinol (Lausanne) 2017; 8:55. [PMID: 28382019 PMCID: PMC5360720 DOI: 10.3389/fendo.2017.00055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 03/03/2017] [Indexed: 12/16/2022] Open
Abstract
ACTH-dependent hypercortisolism caused by a pituitary adenoma [Cushing's disease (CD)] is the most common cause of endogenous Cushing's syndrome. CD is often associated with several morbidities, including hypertension, diabetes, osteoporosis/bone fractures, secondary infections, and increased cardiovascular mortality. While the majority (≈80%) of the corticotrophinomas visible on pituitary magnetic resonance imaging are microadenomas (MICs, <10 mm of diameter), some tumors are macroadenomas (MACs, ≥10 mm) with increased growth potential and invasiveness, exceptionally exhibiting malignant demeanor. In addition, larger and invasive MACs are associated with a significant increased risk of local complications, such as hypopituitarism and visual defects. Given the clinical and molecular heterogeneity of corticotrophinomas, the aim of this study was to investigate the pattern of genetic differential expression between MIC and MAC, including the invasiveness grade as a criterion for categorizing these tumors. In this study, were included tumor samples from patients with clinical, laboratorial, radiological, and histopathological diagnosis of hypercortisolism due to an ACTH-producing pituitary adenoma. Differential gene expression was studied using an Affymetrix microarray platform in 12 corticotrophinomas, classified as non-invasive MIC (n = 4) and MAC (n = 5), and invasive MAC (n = 3), according to modified Hardy criteria. Somatic mutations in USP8 were also investigated, but none of the patients exhibited USP8 variants. Differential expression analysis demonstrated that non-invasive MIC and MAC have a similar genetic signature, while invasive MACs exhibited a differential expression profile. Among the genes differentially expressed, we highlighted CCND2, ZNF676, DAPK1, and TIMP2, and their differential expression was validated through quantitative real-time PCR in another cohort of 15 non-invasive and 3 invasive cortocotrophinomas. We also identified potential biological pathways associated with growth and invasiveness, TGF-β and G protein signaling pathways, DNA damage response pathway, and pathways associated with focal adhesion. Our study revealed a differential pattern of genetic signature in a subgroup of MAC, supporting a genetic influence on corticotrophinomas in patients with CD.
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Affiliation(s)
- Leonardo Jose Tadeu de Araújo
- Laboratory of Hormones and Molecular Genetics LIM-42, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Quantitative Pathology, Center of Pathology, Adolfo Lutz Institute, São Paulo, Brazil
| | - Antonio Marcondes Lerario
- Laboratory of Hormones and Molecular Genetics LIM-42, University of São Paulo Medical School, São Paulo, Brazil
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, United States
| | - Margaret de Castro
- Internal Medicine Department, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Clarissa Silva Martins
- Internal Medicine Department, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Marcello Delano Bronstein
- Laboratory of Hormones and Molecular Genetics LIM-42, University of São Paulo Medical School, São Paulo, Brazil
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcio Carlos Machado
- Laboratory of Hormones and Molecular Genetics LIM-42, University of São Paulo Medical School, São Paulo, Brazil
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, São Paulo, Brazil
- Endocrinology Service, AC Cancer Center, São Paulo, Brazil
| | - Ericka Barbosa Trarbach
- Laboratory of Cellular and Molecular Endocrinology LIM-25, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Candida Barisson Villares Fragoso
- Laboratory of Hormones and Molecular Genetics LIM-42, University of São Paulo Medical School, São Paulo, Brazil
- Endocrinology Service, AC Cancer Center, São Paulo, Brazil
- *Correspondence: Maria Candida Barisson Villares Fragoso,
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16
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Siegel S, Milian M, Kleist B, Psaras T, Tsiogka M, Führer D, Koltowska-Häggström M, Honegger J, Müller O, Sure U, Menzel C, Buchfelder M, Kreitschmann-Andermahr I. Coping strategies have a strong impact on quality of life, depression, and embitterment in patients with Cushing's disease. Pituitary 2016; 19:590-600. [PMID: 27590785 DOI: 10.1007/s11102-016-0750-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Quality of life (QoL) and psychosocial well-being are substantially impaired in patients with Cushing's disease (CD), not only at the acute illness stage but also after therapy; however, the reason for these impairments remains unclear. METHODS In this cross-sectional, patient-reported outcome study, we conducted a postal survey on psychosocial impairment and coping strategies in patients after surgical treatment of CD in three large tertiary referral centers. In total, 176 patients with CD completed a compilation of self-assessment inventories pertaining to depression (Hospital Anxiety and Depression Scale, HADS), QoL (Short Form SF-36, Tuebingen CD; Tuebingen CD-25), coping style (Freiburg questionnaire on coping with illness, FKV-LIS), and embitterment (Bern Embitterment Inventory), on average 6.8 ± 6.66 years after surgery. Regression analyses were performed to identify predictors of psychosocial impairment. RESULTS At the time of the study, 21.8 % of patients suffered from anxiety, 18.7 % experienced an above-average feeling of embitterment, and 13.1 % suffered from depression. Maladaptive coping styles (FKV-LIS subscales depressive coping and minimizing importance) emerged as robust and strong predictors of psychosocial impairment in all inventories; while age, sex, and hydrocortisone intake failed to explain the variance in these measures. CONCLUSION Similar to several studies in non-pituitary patient cohorts (e.g., patients with multiple sclerosis or lower back pain), our results indicate that psychosocial impairment in CD is significantly influenced by how the patient deals with the illness. Therefore, psychological training of positive coping styles could be a helpful complementary therapy in the overall treatment strategy of CD.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Department of Neurosurgery, University of Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany
| | - Monika Milian
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seylerstrasse 3, 72076, Tuebingen, Germany
| | - Bernadette Kleist
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Tsambika Psaras
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seylerstrasse 3, 72076, Tuebingen, Germany
| | - Maria Tsiogka
- Department of Endocrinology and Metabolic Diseases, University of Duisburg-Essen, Hufelandstraße 55, 45171, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology and Metabolic Diseases, University of Duisburg-Essen, Hufelandstraße 55, 45171, Essen, Germany
| | - Maria Koltowska-Häggström
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, SE 751 85, Uppsala, Sweden
| | - Jürgen Honegger
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seylerstrasse 3, 72076, Tuebingen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Christa Menzel
- Department of Neurosurgery, University of Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nuremberg, Schlossplatz 4, 91054, Erlangen, Germany
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17
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Diernaes JEF, Bygum A, Poulsen PL. Unmasking sarcoidosis following surgery for Cushing disease. DERMATO-ENDOCRINOLOGY 2016; 8:e983688. [PMID: 27375832 PMCID: PMC4909375 DOI: 10.4161/derm.29855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/18/2014] [Accepted: 07/08/2014] [Indexed: 12/02/2022]
Abstract
We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman presented with symptoms of hypercortisolism such as progressive weight gain, Cushingoid appearance, proximal myopathy, easy bruising, and amenorrhea. Blood testing including inferior petrosal sinus sampling uncovered an ACTH-producing microadenoma in the right aspect of the anterior pituitary gland for which the patient underwent transphenoidal resection. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing disease began to resolve. Three months after surgery, multiple erythematous painful nodules developed on the patient's arms. Erythema nodosum (EN) was diagnosed clinically and a suspicion of underlying sarcoidosis was substantiated by lung imaging and elevated plasma interleukin (IL)-2 receptor. One month later, the lesions spontaneously resolved without therapy other than maintenance glucocorticoid replacement. Physicians should be aware that patients undergoing successful treatment of Cushing syndrome may have a flare-up or emergence of a corticosteroid-responsive disease.
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Affiliation(s)
- Jon E F Diernaes
- Department of Dermatology, Aarhus University Hospital , Aarhus, Denmark
| | - Anette Bygum
- Department of Dermatology and Allergy Centre, Odense University Hospital , Odense, Denmark
| | - Per L Poulsen
- Department of Endocrinology, Aarhus University Hospital , Aarhus, Denmark
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18
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Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BMK, Colao A. Complications of Cushing's syndrome: state of the art. Lancet Diabetes Endocrinol 2016; 4:611-29. [PMID: 27177728 DOI: 10.1016/s2213-8587(16)00086-3] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/06/2015] [Accepted: 03/01/2016] [Indexed: 01/13/2023]
Abstract
Cushing's syndrome is a serious endocrine disease caused by chronic, autonomous, and excessive secretion of cortisol. The syndrome is associated with increased mortality and impaired quality of life because of the occurrence of comorbidities. These clinical complications include metabolic syndrome, consisting of systemic arterial hypertension, visceral obesity, impairment of glucose metabolism, and dyslipidaemia; musculoskeletal disorders, such as myopathy, osteoporosis, and skeletal fractures; neuropsychiatric disorders, such as impairment of cognitive function, depression, or mania; impairment of reproductive and sexual function; and dermatological manifestations, mainly represented by acne, hirsutism, and alopecia. Hypertension in patients with Cushing's syndrome has a multifactorial pathogenesis and contributes to the increased risk for myocardial infarction, cardiac failure, or stroke, which are the most common causes of death; risks of these outcomes are exacerbated by a prothrombotic diathesis and hypokalaemia. Neuropsychiatric disorders can be responsible for suicide. Immune disorders are common; immunosuppression during active disease causes susceptibility to infections, possibly complicated by sepsis, an important cause of death, whereas immune rebound after disease remission can exacerbate underlying autoimmune diseases. Prompt treatment of cortisol excess and specific treatments of comorbidities are crucial to prevent serious clinical complications and reduce the mortality associated with Cushing's syndrome.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Cristina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - John Newell-Price
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK; The Endocrine Unit, The Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Beverly M K Biller
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
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19
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The hypertension of Cushing's syndrome: controversies in the pathophysiology and focus on cardiovascular complications. J Hypertens 2016; 33:44-60. [PMID: 25415766 PMCID: PMC4342316 DOI: 10.1097/hjh.0000000000000415] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies among published studies. The pleiotropic effects of glucocorticoids and the overlap of the several regulatory mechanisms controlling blood pressure suggest that a rigorous comparison of in-vivo and in-vitro studies is necessary to draw reliable conclusions. This review, developed during the first ‘Altogether to Beat Cushing's syndrome’ workshop held in Capri in 2012, evaluates the most important peculiarities of hypertension associated with CS, with a particular focus on its pathophysiology. A critical appraisal of most significant animal and human studies is compared with a systematic review of the few available clinical trials. A special attention is dedicated to the description of the clinical features and cardiovascular damage secondary to glucocorticoid excess. On the basis of the consensus reached during the workshop, a pathophysiology-oriented therapeutic algorithm has been developed and it could serve as a first attempt to rationalize the treatment of hypertension in Cushing's syndrome.
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20
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Burkhardt T, Lüdecke D, Spies L, Wittmann L, Westphal M, Flitsch J. Hippocampal and cerebellar atrophy in patients with Cushing’s disease. Neurosurg Focus 2015; 39:E5. [DOI: 10.3171/2015.8.focus15324] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Cushing’s disease (CD) may cause atrophy of different regions of the human brain, mostly affecting the hippocampus and the cerebellum. This study evaluates the use of 3-T MRI of newly diagnosed patients with CD to detect atrophic degeneration with voxel-based volumetry.
METHODS
Subjects with newly diagnosed, untreated CD were included and underwent 3-T MRI. Images were analyzed using a voxelwise statistical test to detect reduction of brain parenchyma. In addition, an atlas-based volumetric study for regions likely to be affected by CD was performed.
RESULTS
Nineteen patients with a mean disease duration of 24 months were included. Tumor markers included adre-nocorticotropic hormone (median 17.5 pmol/L), cortisol (949.4 nmol/L), and dehydroepiandrosterone sulfate (5.4 μmol/L). The following values are expressed as the mean ± SD. The voxelwise statistical test revealed clusters of significantly reduced gray matter in the hippocampus and cerebellum, with volumes of 2.90 ± 0.26 ml (right hippocampus), 2.89 ± 0.28 ml (left hippocampus), 41.95 ± 4.67 ml (right cerebellar hemisphere), and 42.11 ± 4.59 ml (left cerebellar hemisphere). Healthy control volunteers showed volumes of 3.22 ± 0.25 ml for the right hippocampus, 3.23 ± 0.25 ml for the left hippocampus, 50.87 ± 4.23 ml for the right cerebellar hemisphere, and 50.42 ± 3.97 ml for the left cerebellar hemisphere.
CONCLUSIONS
Patients with untreated CD show significant reduction of gray matter in the cerebellum and hippocampus. These changes can be analyzed and objectified with the quantitative voxel-based method described in this study.
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Affiliation(s)
| | - Daniel Lüdecke
- 2Psychiatry, University Medical Center Hamburg-Eppendorf; and
| | | | - Linus Wittmann
- 2Psychiatry, University Medical Center Hamburg-Eppendorf; and
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21
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Pivonello R, De Leo M, Cozzolino A, Colao A. The Treatment of Cushing's Disease. Endocr Rev 2015; 36:385-486. [PMID: 26067718 PMCID: PMC4523083 DOI: 10.1210/er.2013-1048] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/13/2015] [Indexed: 12/23/2022]
Abstract
Cushing's disease (CD), or pituitary-dependent Cushing's syndrome, is a severe endocrine disease caused by a corticotroph pituitary tumor and associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 78% and relapse in around 13% of patients during the 10-year period after surgery, so that nearly one third of patients experience in the long-term a failure of surgery and require an additional second-line treatment. Patients with persistent or recurrent CD require additional treatments, including pituitary radiotherapy, adrenal surgery, and/or medical therapy. Pituitary radiotherapy is effective in controlling cortisol excess in a large percentage of patients, but it is associated with a considerable risk of hypopituitarism. Adrenal surgery is followed by a rapid and definitive control of cortisol excess in nearly all patients, but it induces adrenal insufficiency. Medical therapy has recently acquired a more important role compared to the past, due to the recent employment of novel compounds able to control cortisol secretion or action. Currently, medical therapy is used as a presurgical treatment, particularly for severe disease; or as postsurgical treatment, in cases of failure or incomplete surgical tumor resection; or as bridging therapy before, during, and after radiotherapy while waiting for disease control; or, in selected cases, as primary therapy, mainly when surgery is not an option. The adrenal-directed drug ketoconazole is the most commonly used drug, mainly because of its rapid action, whereas the glucocorticoid receptor antagonist, mifepristone, is highly effective in controlling clinical comorbidities, mainly glucose intolerance, thus being a useful treatment for CD when it is associated with diabetes mellitus. Pituitary-directed drugs have the advantage of acting at the site responsible for CD, the pituitary tumor. Among this group of drugs, the dopamine agonist cabergoline and the somatostatin analog pasireotide result in disease remission in a consistent subgroup of patients with CD. Recently, pasireotide has been approved for the treatment of CD when surgery has failed or when surgery is not an option, and mifepristone has been approved for the treatment of Cushing's syndrome when associated with impairment of glucose metabolism in case of the lack of a surgical indication. Recent experience suggests that the combination of different drugs may be able to control cortisol excess in a great majority of patients with CD.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Monica De Leo
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Alessia Cozzolino
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
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Petersenn S, Beckers A, Ferone D, van der Lely A, Bollerslev J, Boscaro M, Brue T, Bruzzi P, Casanueva FF, Chanson P, Colao A, Reincke M, Stalla G, Tsagarakis S. Therapy of endocrine disease: outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence. Eur J Endocrinol 2015; 172:R227-39. [PMID: 25599709 DOI: 10.1530/eje-14-0883] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/15/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's disease - including different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence. METHODS We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed. RESULTS Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience. CONCLUSIONS The variety of methodologies used in clinical evaluation of TSS for Cushing's disease strongly support the call for standardization and optimization of studies to inform clinical practice and maximize patient outcomes. Clinically significant rates of failure of initial TSS highlight the need for effective second-line treatments.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Albert Beckers
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Diego Ferone
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Aart van der Lely
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Jens Bollerslev
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Marco Boscaro
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Thierry Brue
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Inter
| | - Paolo Bruzzi
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Felipe F Casanueva
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Philippe Chanson
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Inter
| | - Annamaria Colao
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Martin Reincke
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Günter Stalla
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Stelios Tsagarakis
- ENDOC Center for Endocrine TumorsAltonaer Strasse 59, 20357 Hamburg, GermanyDepartment of EndocrinologyCHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, BelgiumEndocrinology UnitDepartment of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, IRCCS AOU San Martino-IST, University of Genova, Genova, ItalyDepartment of MedicineErasmus University MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsSection of Specialized EndocrinologyFaculty of Medicine, Oslo University Hospital, University of Oslo, Oslo, NorwayDivision of EndocrinologyDepartment of Medicine (DIMED), University of Padua, Padua, ItalyAix-Marseille UniversitéCNRS, CRN2M UMR 7286, 13344 Marseille Cedex 15, FranceAPHMHôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, 13385 Marseille Cedex 15, FranceDepartment of Epidemiology and PreventionIRCCS AOU San Martino-IST, Genova, ItalySantiago de Compostela University and CIBERobnSantiago de Compostela, SpainUniv Paris-SudFaculté de Médecine Paris-Sud, UMR-S1185, Le Kremlin Bicêtre, F-94276, FranceAssistance Publique-Hôpitaux de ParisHôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, F-94275, FranceInstitut National de la Santé et de la Recherche Médicale U1185Le Kremlin Bicêtre, F-94276, FranceDipartimento di Medicina Clinica e ChirurgiaSezione di Endocrinologia, Università Federico II di Napoli, Naples, ItalyMedizinische Klinik und Poliklinik IV-InnenstadtUniversity Hospital Munich, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, Munich, GermanyDepartment of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, Athens, Greece
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Pivonello R, Simeoli C, De Martino MC, Cozzolino A, De Leo M, Iacuaniello D, Pivonello C, Negri M, Pellecchia MT, Iasevoli F, Colao A. Neuropsychiatric disorders in Cushing's syndrome. Front Neurosci 2015; 9:129. [PMID: 25941467 PMCID: PMC4403344 DOI: 10.3389/fnins.2015.00129] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/28/2015] [Indexed: 01/19/2023] Open
Abstract
Endogenous Cushing's syndrome (CS), a rare endocrine disorder characterized by cortisol hypersecretion, is associated with psychiatric and neurocognitive disorders. Major depression, mania, anxiety, and neurocognitive impairment are the most important clinical abnormalities. Moreover, patients most often complain of impairment in quality of life, interference with family life, social, and work performance. Surprisingly, after hypercortisolism resolution, despite the improvement of the overall prevalence of psychiatric and neurocognitive disorders, the brain volume loss at least partially persists and it should be noted that some patients may still display depression, anxiety, panic disorders, and neurocognitive impairment. This brief review aimed at describing the prevalence of psychiatric and neurocognitive disorders and their characterization both during the active and remission phases of CS. The last section of this review is dedicated to quality of life, impaired during active CS and only partially resolved after resolution of hypercortisolism.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Maria Cristina De Martino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Alessia Cozzolino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Monica De Leo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Davide Iacuaniello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Mariarosaria Negri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine and Surgery, Center for Neurodegenerative Diseases, University of SalernoSalerno, Italy
| | - Felice Iasevoli
- Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Università “Federico II”Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II”Naples, Italy
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Gkourogianni A, Lodish MB, Zilbermint M, Lyssikatos C, Belyavskaya E, Keil MF, Stratakis CA. Death in pediatric Cushing syndrome is uncommon but still occurs. Eur J Pediatr 2015; 174:501-7. [PMID: 25241829 PMCID: PMC4370787 DOI: 10.1007/s00431-014-2427-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/11/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Cushing syndrome (CS) in children is rare. Delayed diagnosis and treatment of CS may be associated with increased morbidity and, unfortunately, mortality. We performed a retrospective review of all patients with CS under the age of 18 years referred to the National Institutes of Health (NIH) from 1998 to 2013 in order to describe deceased patients among cases of pediatric CS referred to the National Institutes of Health (NIH). The deaths of four children (three females and one male), aged 7.5-15.5 years (mean age 11.2 years) with length of disease 2-4 years, were recorded among 160 (2.5 %) children seen at or referred to the NIH over the last 15 years. All died at different institutions, prior to coming to the NIH (two) or after leaving NIH (two). Presenting symptoms included increasing weight and decreasing height gain, facial plethora, dorsocervical fat pad (webbed neck), striae, headache, vision disturbances, and depression and other mood or behavior changes; there were no differences between how these patients presented and the others in our cohort. The causes of CS in the deceased patients were also not different, in fact, they spanned the entire spectrum of CS: pituitary disease (one), ectopic corticotropin production (one), and primary adrenal hyperplasia (one). In one patient, the cause of CS could not be verified. Three died of sepsis and one due to residual disease and complications of the primary tumor. CONCLUSIONS Despite the advances in early diagnosis and treatment of pediatric CS, a 2.5 % mortality rate was identified in a large cohort of patients with this condition referred to an experienced, tertiary care referral center (although these deaths occurred elsewhere). Pediatricians need to recognize the possibility of death, primarily due to sepsis, in a patient with pediatric CS and treat accordingly.
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Affiliation(s)
- Alexandra Gkourogianni
- Section on Endocrinology and Genetics and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Clinical Research Center, 10 Center Drive, Building 10, Room 1-3330, MSC1103, Bethesda, MD, 20892, USA,
| | - Maya B. Lodish
- Corresponding author: Maya B. Lodish, MD, Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Clinical Research Center, 10 Center Drive, Building 10, Room 1-3330, MSC1103, Bethesda, Maryland 20892, USA; Tel 001-301-451-7175; FAX 001-301-480-0378;
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25
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Dimopoulou C, Athanasoulia AP, Hanisch E, Held S, Sprenger T, Toelle TR, Roemmler-Zehrer J, Schopohl J, Stalla GK, Sievers C. Clinical characteristics of pain in patients with pituitary adenomas. Eur J Endocrinol 2014; 171:581-91. [PMID: 25117460 DOI: 10.1530/eje-14-0375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. DESIGN In a cross-sectional study, we assessed 278 patients with pituitary disease (n=81 acromegaly; n=45 Cushing's disease; n=92 prolactinoma; n=60 non-functioning pituitary adenoma). METHODS Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). RESULTS We recorded a high prevalence of bodily pain (n=180, 65%) and headache (n=178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (n=34, 76%). Headache was equally frequent in patients with macro- and microadenomas (68 vs 60%; P=0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (n=193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL. CONCLUSIONS Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL.
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Affiliation(s)
- C Dimopoulou
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - A P Athanasoulia
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - E Hanisch
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - S Held
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - T Sprenger
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - T R Toelle
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - J Roemmler-Zehrer
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - J Schopohl
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - G K Stalla
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
| | - C Sievers
- Department of EndocrinologyMax Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, GermanyDepartment of NeurologyTechnische Universität München, Munich, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-University, Munich, GermanyDepartment of NeurologyUniversity Hospital Basel, Basel, SwitzerlandDivision of NeuroradiologyDepartment of Radiology, University Hospital Basel, Basel, Switzerland
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Colao A, Boscaro M, Ferone D, Casanueva FF. Managing Cushing's disease: the state of the art. Endocrine 2014; 47:9-20. [PMID: 24415169 DOI: 10.1007/s12020-013-0129-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/21/2013] [Indexed: 12/28/2022]
Abstract
Cushing's disease is a rare chronic disease caused by a pituitary adenoma, which leads to excess secretion of adrenocorticotropic hormone (ACTH). The over-production of ACTH leads to hyperstimulation of the adrenal glands and a chronic excess of cortisol, resulting in the signs and symptoms of a severe clinical state (Cushing's syndrome) that leads to significant morbidity, negative impacts on the patient's quality of life, and, if untreated, increased mortality. The management of patients with Cushing's disease is complicated by the heterogeneity of the condition, with signs and symptoms that overlap with those of other diseases, and high subclinical incidence rates. Controversies surrounding the tests used for screening and identifying patients with Cushing's disease add to the challenge of patient management. Surgical intervention to remove the adenoma is the first-line treatment for patients with Cushing's disease, but medical therapies are useful in patients who relapse or are unsuitable for surgery. The recent introduction of pasireotide, the first pituitary-directed medical therapy, expands the number of treatment options available for patients with Cushing's disease. This state-of-the-art review aims to provide an overview of the most recent scientific research and clinical information regarding Cushing's disease. Continuing research into improving the diagnosis and treatment of Cushing's disease will help to optimize patient management.
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Affiliation(s)
- Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy,
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27
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Terzolo M, Allasino B, Pia A, Peraga G, Daffara F, Laino F, Ardito A, Termine A, Paccotti P, Berchialla P, Migliaretti G, Reimondo G. Surgical remission of Cushing's syndrome reduces cardiovascular risk. Eur J Endocrinol 2014; 171:127-36. [PMID: 24801586 DOI: 10.1530/eje-13-0555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Recent studies have questioned the reversibility of complications of Cushing's syndrome (CS) after successful surgical treatment. The aim of this study was to assess the outcome of patients with CS who achieved disease remission compared with those patients with persistent hypercortisolism and matched controls. DESIGN A retrospective study of 75 patients with CS followed at an academic center. METHODS Cardiovascular risk profile was evaluated in 51 patients with CS in remission (group 1) and 24 patients with persistent disease (group 2) and compared with 60 controls. Mortality of patients with CS was compared with the background population. RESULTS In group 1, the frequency of cardiovascular risk factors dropped after disease remission even if it remained higher at the last follow-up than in the control group. In group 2, the frequency of cardiovascular risk factors remained unchanged during follow-up. The rate of cardiovascular and thromboembolic events was higher in group 2 than in group 1, as was the mortality rate (two deaths in group 1 and nine in group 2; ratio of two SMRs, 0.11; 95% CI, 0.011-0.512). Survival was significantly longer in group 1 than in group 2 (87 months, 80-98 vs 48 months, 38-62; P<0.0001). CONCLUSIONS Successful surgical treatment of hypercortisolism significantly improves cardiovascular risk and may reduce the mortality rate. Patients with persistent disease have increased morbidity and mortality when compared with patients in remission.
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Affiliation(s)
- M Terzolo
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - B Allasino
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - A Pia
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - G Peraga
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - F Daffara
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - F Laino
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - A Ardito
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - A Termine
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - P Paccotti
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - P Berchialla
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - G Migliaretti
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
| | - G Reimondo
- Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
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28
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Scillitani A, Mazziotti G, Di Somma C, Moretti S, Stigliano A, Pivonello R, Giustina A, Colao A. Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how? Osteoporos Int 2014; 25:441-6. [PMID: 24311114 DOI: 10.1007/s00198-013-2588-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 08/21/2013] [Indexed: 01/29/2023]
Abstract
Guidelines for the management of osteoporosis induced by endogenous hypercortisolism are not available. Both the American College of Rheumatology and the International Osteoporosis Foundation recommend to modulate the treatment of exogenous glucocorticoid-induced osteoporosis (GIO) based on the individual fracture risk profile (calculated by FRAX) and dose of glucocorticoid used, but it is difficult to translate corticosteroid dosages to different degrees of endogenous hypercortisolism, and there are no data on validation of FRAX stratification method in patients with endogenous hypercortisolism. Consequently, it is unclear whether such recommendations may be adapted to patients with endogenous hypercortisolism. Moreover, patients with exogenous GIO take glucocorticoids since suffering a disease that commonly affects bone. On the other hand, the correction of coexistent risk factors, which may contribute to increase the fracture risk in patients exposed to glucocorticoid excess, and the removal of the cause of endogenous hypercortisolism, may lead to the recovery of bone health. Although the correction of hypercortisolism and of possible coexistent risk factors is necessary to favor the normalization of bone turnover with recovery of bone mass; in some patients, the fracture risk could not be normalized and specific anti-osteoporotic drugs should be given. Who, when, and how the patient with endogenous hypercortisolism should be treated with bone-active therapy is discussed.
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Affiliation(s)
- A Scillitani
- Unit of Endocrinology, "Casa Sollievo della Sofferenza" Hospital, 71013, San Giovanni Rotondo, Italy,
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29
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Aulinas A, Valassi E, Webb SM. Pronóstico del paciente tratado de síndrome de Cushing. ACTA ACUST UNITED AC 2014; 61:52-61. [DOI: 10.1016/j.endonu.2013.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/07/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022]
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Fleseriu M, Molitch ME, Gross C, Schteingart DE, Vaughan TB, Biller BMK. A new therapeutic approach in the medical treatment of Cushing's syndrome: glucocorticoid receptor blockade with mifepristone. Endocr Pract 2013; 19:313-26. [PMID: 23337135 DOI: 10.4158/ep12149.ra] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cushing's syndrome (CS) is a serious endocrine disorder caused by prolonged exposure to high cortisol levels. Initial treatment of this condition is dependent upon the cause, but is generally surgical. For patients whose hypercortisolism is not cured by surgery, medical therapy is often required. Drugs that have typically been used for CS medical therapy act by decreasing cortisol levels. Mifepristone is a glucocorticoid receptor antagonist now available for use in patients with CS. Unlike other agents, mifepristone does not decrease cortisol levels, but directly antagonizes its effects. Our objective is to review the pharmacology and clinical use of this novel agent and to discuss detailed guidance on the management of CS patients treated with mifepristone. METHODS We review the literature regarding mifepristone use in CS and recently published clinical trial data. Detailed information related to clinical assessment of mifepristone use, potential drug interactions, drug initiation and dose titration, and monitoring of drug tolerability are provided. RESULTS Clinical trial data have shown that mifepristone improves glycemic control and blood pressure, causes weight loss and a decrease in waist circumference, lessens depression, and improves overall wellbeing. However, adverse effects include adrenal insufficiency, hypokalemia, and endometrial thickening with vaginal bleeding. These findings are supported by the earlier literature case reports. CONCLUSION This article provides a review of the pharmacology and clinical use of mifepristone in Cushing's syndrome, as well as detailed guidance on the management of patients treated with this novel agent.
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Affiliation(s)
- Maria Fleseriu
- Oregon Health & Science University, Portland, OR 97239, USA.
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31
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Abstract
The purpose was to review the use of mifepristone in the treatment of Cushing's syndrome (CS) in the context of other recently published studies. We review the use of mifepristone, as published in the recent Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing's Syndrome (SEISMIC). We also review the multiple case reports and case series of mifepristone use in CS. A review of other medications used in the treatment of Cushing's disease (CD), including pasireotide and cabergoline also provides context for the discussion of the role of mifepristone in the treatment of CD. The results show that the treatment of CD has been primarily surgical with medical therapy reserved for adjuvant therapy when primary treatment fails or other therapies require time for optimal efficacy. Two recent large prospective studies, using pasireotide and mifepristone provide new clinical insights to the medical treatment of CD in particular. Mifepristone has been used to treat excessive cortisol production by blocking the action of cortisol at the level of the glucocorticoid receptor. Until recently, the majority of clinical experience with mifepristone on the treatment of excess cortisol was derived from case reports and small case series. Based on the SEISMIC study, mifepristone was FDA approved for hyperglycemia associated with CS. In conclusion the role of mifepristone in the treatment of CD remains one of adjuvant therapy. Its place among other choices for medical therapy has yet to be firmly established and an evidenced-based approach toward the use of novel medications in the treatment of CD has not been made. Selection of medication depends on drug approval and availability in individual countries and requires cautious assessment of potential adverse effects, consideration of patient comorbidities, and efficacy.
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Affiliation(s)
- John D Carmichael
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA,
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Colao A, Simeoli C, De Leo M, Cozzolino A, Pivonello R. Pasireotide for the treatment of Cushing's disease. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.807731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Moreira RPP, Bachega TASS, Machado MC, Mendonca BB, Bronstein MD, Villares Fragoso MCB. Modulatory effect of BclI GR gene polymorphisms on the obesity phenotype in Brazilian patients with Cushing's disease. Clinics (Sao Paulo) 2013; 68:579-85. [PMID: 23778418 PMCID: PMC3654304 DOI: 10.6061/clinics/2013(05)01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/02/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Patients with Cushing's disease exhibit wide phenotypic variability in the severity of obesity, diabetes and hypertension. In the general population, several glucocorticoid receptor genes (NR3C1) and HSD11B1 polymorphisms are associated with altered glucocorticoid sensitivity and/or metabolism, resulting in an increased or reduced risk of an adverse metabolic profile. Our aim was to analyze the association of NR3C1 and HSD11B1 gene variants with the severity of some clinical and hormonal features of Cushing's disease. METHODS Sixty-four patients presenting with Cushing's disease were diagnosed based on adrenocorticotrophic hormone levels, high-dose dexamethasone suppression tests and/or inferior petrosal sinus sampling and magnetic resonance imaging. The A3669G, ER22/23EK, N363S BclI-NR3C1 and HSD11B1-rs12086634 variants were screened. RESULTS The BclI, HSD11B1-rs12086634 and A3669G variants were found in 36%, 19.5% and 14% of alleles, respectively. The N363S and ER22/23EK polymorphisms were identified in heterozygosis once in only two patients (1.5% of alleles). There were no differences in the weight gain or prevalence of diabetes and hypertension in the patients carrying the abovementioned alleles compared to the wild-type carriers. Interestingly, the mean body mass index (BMI) of the BclI carriers was significantly higher than the non-carriers (34.4±7 kg/m2 vs. 29.6±4.7 kg/m2, respectively). None of the polymorphisms were associated with the basal adrenocorticotrophic hormone, FU levels or F level after dexamethasone suppression testing. CONCLUSION Although Cushing's disease results from increased glucocorticoid secretion, we observed that interindividual variability in the peripheral glucocorticoid sensitivity, mediated by the glucocorticoid receptor, could modulate the obesity phenotype.
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Affiliation(s)
- Ricardo P P Moreira
- Faculdade de Medicina, Universidade de São PauloUnidade de Suprarrenal, Laboratório de Hormônios e Genética Molecular LIM/42, São PauloSP, Brazil
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Abstract
Recent evidence supports the notion that the incidence of Cushing disease is higher than previously thought. Transphenoidal surgery, in the hands of experienced neurosurgeons, is currently considered the first-line treatment of choice. However, an examination of remission and recurrence rates in long-term follow-up studies reveals that potentially up to 40% to 50% of patients could require additional treatment. If left untreated, the resultant morbidity and mortality are high. Successful clinical management of patients with Cushing disease remains a challenge. The development of new therapeutic agents has been eagerly anticipated. This article discusses the results of currently available and promising new therapeutic agents used to treat this challenging disease.
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Milian M, Honegger J, Teufel P, Wolf A, Psaras T. Tuebingen CD-25 is a sensitive tool to investigate health-related quality of life in Cushing's disease patients in the course of the disease. Neuroendocrinology 2013; 98:188-99. [PMID: 24080783 DOI: 10.1159/000355622] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The primary object was to investigate whether the Tuebingen CD-25 captures changes in health-related quality of life (HRQoL) sensitively in Cushing's disease (CD) and to identify factors that favour postoperative HRQoL. METHODS 17 CD patients were scheduled for transsphenoidal tumour removal and filled out the inventory before and after surgery. The mean time elapsed after surgery was 14.4 ± 11.3 months. All patients were in remission at the second timepoint of investigation. RESULTS HRQoL as assessed with the Tuebingen CD-25 improved significantly after successful surgical tumour removal. A large effect size (Cohen's d = 0.84) in the total score indicates good sensitivity to change. 13 patients (76.5%) showed impaired HRQoL preoperatively compared with a general population sample. Postoperatively, 35.3% of the patients still suffered from an impaired HRQoL. Stepwise linear regression analysis revealed that less comorbidities (≤2) and greater morning cortisol decrease were promotive factors for better postoperative HRQoL (p < 0.05). The postoperative improvement in HRQoL could be best predicted by the presence of preoperative HRQoL impairment and age of the patients, i.e. patients who were younger were more likely to improve. Moreover, patients without postoperative pituitary deficiencies improved significantly more in the cognition scale. A tendency towards more improvement in overall HRQoL was observed in non-hypocortisolaemic patients. CONCLUSIONS The Tuebingen CD-25 has proved to be a capable and sensitive instrument to investigate HRQoL in the course of disease. The number of postoperative comorbidities had the greatest impact on postoperative well-being.
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Affiliation(s)
- Monika Milian
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
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Miceli D, Gallelli M, Cabrera Blatter M, Martiarena B, Brañas M, Ortemberg L, Gómez N, Castillo V. Low dose of insulin detemir controls glycaemia, insulinemia and prevents diabetes mellitus progression in the dog with pituitary-dependent hyperadrenocorticism. Res Vet Sci 2012; 93:114-20. [DOI: 10.1016/j.rvsc.2011.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 05/04/2011] [Accepted: 07/08/2011] [Indexed: 10/18/2022]
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Hatipoglu BA. Cushing's syndrome. J Surg Oncol 2012; 106:565-71. [DOI: 10.1002/jso.23197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/22/2012] [Indexed: 12/29/2022]
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Affiliation(s)
- Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, University Federico II of Naples, Naples, Italy.
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Graversen D, Vestergaard P, Stochholm K, Gravholt CH, Jørgensen JOL. Mortality in Cushing's syndrome: a systematic review and meta-analysis. Eur J Intern Med 2012; 23:278-82. [PMID: 22385888 DOI: 10.1016/j.ejim.2011.10.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022]
Abstract
CONTEXT Data on mortality associated with Cushing's disease (CD) and Cushing's syndrome (CS) are scarce. OBJECTIVE To perform a systematic review and meta-analysis of mortality studies in patients with CD and CS secondary to a benign adrenal adenoma. DATA SOURCES A search was performed in seven electronic databases. Sixty-six articles were retrieved for analysis and 7 included in the final study. The main outcome measure was standardized mortality ratio (SMR). STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies reporting SMR for patients diagnosed with CD and/or CS. Outcomes were stratified by subtype of Cushing's syndrome. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were appraised by two authors and were synthesized using a weighted estimate based on the standard error of the SMR. RESULTS The weighted mean of SMR for patients with CD was 1.84 (95% confidence interval (CI): 1.28-2.65). CD patients with persistent disease after initial surgery had a SMR of 3.73 (95% CI: 2.31-6.01), whereas mortality of CD patients with initial remission did not differ significantly from the general population (SMR: 1.23 (95% CI: 0.51-2.97)). SMR for patients with a benign adrenal adenoma was 1.90 (95% CI: 0.93-3.91). Age, sex and observation time did not significantly impact mortality. CONCLUSIONS CD as opposed to CS due to a benign adrenal adenoma is associated with an excess mortality, which is attributed to patients in whom initial surgical cure is not obtained. This underlines the importance of a rigorous and early follow-up of newly operated patients with CD.
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Affiliation(s)
- D Graversen
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, Aarhus, Denmark
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Smets P, Meyer E, Maddens B, Daminet S. Cushing's syndrome, glucocorticoids and the kidney. Gen Comp Endocrinol 2010; 169:1-10. [PMID: 20655918 DOI: 10.1016/j.ygcen.2010.07.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 07/08/2010] [Indexed: 11/18/2022]
Abstract
Glucocorticoids (GCs) affect renal development and function in fetal and mature kidneys both indirectly, by influencing the cardiovascular system, and directly, by their effects on glomerular and tubular function. Excess GCs due to endogenous GC overproduction in Cushing's syndrome or exogenous GC administration plays a pivotal role in hypertension and causes increased cardiac output, total peripheral resistance and renal blood flow. Glucocorticoids increase renal vascular resistance (RVR) in some species and experimental settings and decrease RVR in others. Short term administration of adrenocorticotrophic hormone or GCs causes an increased glomerular filtration rate (GFR) in humans, rats, sheep and dogs. Interestingly, chronic exposure may cause a decreased GFR in combination with a higher cardiovascular risk in human patients with Cushing's syndrome. Glomerular dysfunction leads to proteinuria and albuminuria in canine and human Cushing's patients, and some cases also show histological evidence of glomerulosclerosis. Tubular dysfunction is reflected by an impaired urinary concentrating ability and disturbed electrolyte handling, which can potentially result in increased sodium reabsorption, hypercalciuria and urolithiasis. Conversely, chronic kidney disease can also alter GC metabolism. More research needs to be performed to further evaluate the renal consequences of Cushing's syndrome because of its implications for therapeutic aspects as well as the general well-being of the patient. Because there is a high incidence of Cushing's syndrome in canines, which is similar to the syndrome in humans, dogs are an interesting animal model to investigate the link between hypercortisolism and renal function.
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Affiliation(s)
- Pascale Smets
- Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
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Abstract
There has been growing interest in the psychosocial aspects of Cushing's syndrome, such as the role of life stress as a pathogenetic factor, the association with affective disorders, and the presence of residual symptoms after treatment. Interestingly, a temporal relationship between stressful life events and disease onset is relevant only to pituitary-dependent Cushing's disease, and not to the pituitary-independent forms. A number of psychiatric and psychological disturbances may be associated with the active hypercortisolemic state, regardless of its etiology. Within the high frequency of mood disorders (about 60%), major depression is the most common complication. Other psychopathological aspects include mania, anxiety disorders, psychological symptoms (demoralization, irritable mood, somatization) and cognitive impairment. Cognitive symptoms are associated with brain abnormalities (mainly loss of brain volume). Quality of life may be seriously compromised during both active and post-treatment phases. Long-standing hypercortisolism may imply a degree of irreversibility of the pathological process. Recovery, thus, may be delayed and be influenced by highly individualized affective responses. Outcomes of Cushing's syndrome treatment are not fully satisfactory. Within its great complexity, a conceptual shift from a merely biomedical care to a psychosomatic consideration of the person and his/her quality of life appears to be necessary to improve effectiveness. It is time to translate the research evidence that has accumulated into clinical practice initiatives. To patients who show persistence or even worsening of psychological distress upon adequate endocrine treatment psychiatric/psychological interventions should be readily available. Applying interdisciplinary expertise and addressing the needs for rehabilitation would markedly improve final outcome.
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Affiliation(s)
- Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Via Battisti 241, 35121 Padova, Italy.
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Guerrieri M, Campagnacci R, Patrizi A, Romiti C, Arnaldi G, Boscaro M. Primary adrenal hypercortisolism: minimally invasive surgical treatment or medical therapy? A retrospective study with long-term follow-up evaluation. Surg Endosc 2010; 24:2542-6. [PMID: 20336323 DOI: 10.1007/s00464-010-1000-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/29/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because the most suitable management of subclinical Cushing syndrome (SCS, which involves hypersecretion of cortisol without clinically evident disease) still is undefined, the current study aimed to compare retrospectively the outcome for a cohort of patients treated by medical therapy or laparoscopic adrenalectomy (LA). METHODS Over a 12-year period, 47 patients with SCS have been treated by means of LA (19 patients, group A) or medical therapy (28 patients, group B). Group A consisted of 15 women and 4 men with a mean age of 54.8 years. Eight patients had a left adrenal mass, whereas nine had a right adrenal mass, and one patient had bilateral lesion. Group B was composed of 18 women and 10 men with a mean age of 57.8 years. Of these patients, 14 had a left adrenal lesion, 12 had a right adrenal lesion, and 1 had bilateral lesion. The patients were followed up for a mean 4 years (range, 1-11 years) by both an endocrinologist and a surgeon. RESULTS In group A, hypertension improved for 66.3% of the patients; body mass index (BMI) decreased for 47.4%; and hyperlipidemia based on high-density lypoproteins (HDL) cholesterol, total cholesterol ratio, and triglyceridemic concentration improved for 63.2% of the patients. No changes in bone parameters were seen after surgery in SCS patients with osteoporosis. Some patients in group B, during their long-term medical therapy, experienced worsening hypertension (14.2%), hyperlipidemia (17.8%), and diabetes mellitus (8%). CONCLUSIONS This retrospective study focused on a cohort of patients with SCS. Their medium long-term follow-up evaluation showed that LA is better than medical therapy for treating this condition, especially by reducing the cardiovascular risk (hypertension-hyperlipidemia).
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Affiliation(s)
- Mario Guerrieri
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche-Ospedali Riuniti, via Conca 1, 60121, Ancona, Italy
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