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Puglisi S, Perini AME, Botto C, Oliva F, Terzolo M. Long-Term Consequences of Cushing Syndrome: A Systematic Literature Review. J Clin Endocrinol Metab 2024; 109:e901-e919. [PMID: 37536275 DOI: 10.1210/clinem/dgad453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
It is held that the condition of endogenous chronic hypersecretion of cortisol (Cushing syndrome, CS), causes several comorbidities, including cardiovascular and metabolic disorders, musculoskeletal alterations, as well as cognitive and mood impairment. Therefore, CS has an adverse impact on the quality of life and life expectancy of affected patients. What remains unclear is whether disease remission may induce a normalization of the associated comorbid conditions. In order to retrieve updated information on this issue, we conducted a systematic search using the Pubmed and Embase databases to identify scientific papers published from January 1, 2000, to December 31, 2022. The initial search identified 1907 potentially eligible records. Papers were screened for eligibility and a total of 79 were included and classified by the main topic (cardiometabolic risk, thromboembolic disease, bone impairment, muscle damage, mood disturbances and quality of life, cognitive impairment, and mortality). Although the limited patient numbers in many studies preclude definitive conclusions, most recent evidence supports the persistence of increased morbidity and mortality even after long-term remission. It is conceivable that the degree of normalization of the associated comorbid conditions depends on individual factors and characteristics of the conditions. These findings highlight the need for early recognition and effective management of patients with CS, which should include active treatment of the related comorbid conditions. In addition, it is important to maintain a surveillance strategy in all patients with CS, even many years after disease remission, and to actively pursue specific treatment of comorbid conditions beyond cortisol normalization.
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Affiliation(s)
- Soraya Puglisi
- Internal Medicine, San Luigi Hospital, Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy
| | - Anna Maria Elena Perini
- Internal Medicine, San Luigi Hospital, Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy
| | - Cristina Botto
- Internal Medicine, San Luigi Hospital, Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy
| | - Francesco Oliva
- Clinical Psychology Unit, Department of Clinical and Biological Sciences, University Hospital "Città della Salute e della Scienza di Torino", University of Turin, 10126 Turin, Italy
| | - Massimo Terzolo
- Internal Medicine, San Luigi Hospital, Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy
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Page‐Wilson G, Oak B, Silber A, Okeyo JC, Ortiz N, O'Hara M, Moloney S, Geer EB. Holistic burden of illness in patients with endogenous Cushing's syndrome: A systematic literature review. Endocrinol Diabetes Metab 2024; 7:e464. [PMID: 38124436 PMCID: PMC10782070 DOI: 10.1002/edm2.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE The objective of this systematic literature review (SLR) was to summarize the latest studies evaluating the burden of illness in endogenous Cushing's syndrome (CS), including the impact of CS on overall and domain-specific health-related quality of life (HRQoL) and the economic burden of CS to provide a holistic understanding of disease and treatment burden. METHODS An SLR was conducted in PubMed, MEDLINE and Embase using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to identify peer-reviewed manuscripts and conference abstracts published in English from 2015 to December 4, 2020. RESULTS Forty-five publications were eligible for inclusion; data were extracted from 37 primary studies while 8 SLRs were included for reference only. Thirty-one studies reported HRQoL using validated patient reported outcome (PRO) measures in pre- or post-surgery, radiotherapy and pharmacotherapy patients. Overall, this SLR found that patients with CS have worse outcomes relative to healthy populations across specific dimensions, such as depression, despite an improvement in HRQoL post-treatment. These findings reveal that CS symptoms are not fully resolved by the existing care paradigm. Few studies report on the economic burden of CS and currently available data indicate a high direct healthcare system cost burden. CONCLUSIONS Patients with CS experience a significant, complex and multifactorial HRQoL burden. Symptom-specific burden studies are sparse in the literature and the understanding of long-term CS symptomatic burden and economic burden is limited. This review intends to provide an updated reference for clinicians, payers and other stakeholders on the burden of CS as reported in published literature and to encourage further research in this area.
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Affiliation(s)
- Gabrielle Page‐Wilson
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | | | | | - Janetricks C. Okeyo
- Formerly at Strongbridge Biopharma plc, a wholly owned subsidiary of Xeris Biopharma Holdings, Inc.TrevosePennsylvaniaUSA
| | - Nancy Ortiz
- Formerly at Strongbridge Biopharma plc, a wholly owned subsidiary of Xeris Biopharma Holdings, Inc.TrevosePennsylvaniaUSA
| | | | - Stephen Moloney
- Formerly at Strongbridge Biopharma plc, a wholly owned subsidiary of Xeris Biopharma Holdings, Inc.TrevosePennsylvaniaUSA
| | - Eliza B. Geer
- Multidisciplinary Pituitary and Skull Base Tumor CenterMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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Yilmaz N, Tazegul G, Sari R, Avsar E, Altunbas H, Balci M. EFFECTIVENESS OF UNILATERAL ADRENALECTOMY IN BILATERAL ADRENAL INCIDENTALOMA PATIENTS WITH SUBCLINICAL HYPERCORTISOLEMIA. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:479-485. [PMID: 35747873 PMCID: PMC9206144 DOI: 10.4183/aeb.2021.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Unilateral adrenalectomy (UA) is an alternative for treatment in bilateral adrenal incidentaloma (AI) to avoid possible long-term risks of bilateral adrenalectomy. In this study, we aimed to evaluate the effectiveness of UA in bilateral AI patients with subclinical hypercortisolemia (SH). METHOD A total of 35 patients were included in this study. The patients were divided into two groups; those who underwent UA (n=27) and patients without adrenalectomy (PWA) (n=8). Hormone tests related to cortisol mechanism were reviewed to analyze results at the time of diagnosis compared to the latest available results to figure out any changes in cortisol mechanism and determine whether SH has recovered or not. RESULTS Median age of PWA group were higher compared to UA group (p=0.03). Median duration of follow-up in groups were similar (p=0.3). In the PWA group, none of the patients recovered from hypercortisolemia during their follow-up. In UA group 92.6% of the patients went into remission, whereas during follow-up 3.3% had recurred and another 3.3% were found to have post-adrenalectomy persistent SH. Patients in UA group had lower final cortisol level following dexamethasone suppression (p=0.003) and higher final adrenocorticotrophic hormone (ACTH) levels (p=0.001) than patients in PWA group. In UA group, final basal cortisol level (p=0.009) and final cortisol level after 1 mg dexamethasone suppression test (DST) (p=0.004) were lower than corresponding levels at the time of diagnosis. DISCUSSION Our study demonstrates unilateral adrenalectomy targeting the side with the larger lesion is an effective approach to reduce excess cortisol levels in bilateral AI patients with SH.
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Affiliation(s)
- N. Yilmaz
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - G. Tazegul
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkey
| | - R. Sari
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - E. Avsar
- Department of Internal Medicine, Akdeniz University, School of Medicine, Antalya, Turkey
| | - H. Altunbas
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
| | - M.K. Balci
- Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey
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Banariu G, Tica I, Rus M, Stanca I, Onuc S, Neagoe G, Tica V. THE RELATIONSHIP BETWEEN DEPRESSION, ANXIETY DISORDER AND LOW SELF-ESTEEM IN REGARD TO GLYCEMIC VARIABILITY IN DIABETIC PATIENTS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:486-492. [PMID: 35747854 PMCID: PMC9206167 DOI: 10.4183/aeb.2021.486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. METHODS We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). RESULTS A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.
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Affiliation(s)
- G.M. Banariu
- Department of Internal Medicine, “Ovidius” University of Constanta, Faculty of Medicine, Bucharest, Romania
| | - I. Tica
- Department of Internal Medicine, “Ovidius” University of Constanta, Faculty of Medicine, Bucharest, Romania
| | - M. Rus
- Law and Administrative Sciences, “Ovidius” University of Constanta, Faculty of Medicine, Bucharest, Romania
| | - I. Stanca
- “Elias” Emergency University Hospital - Department of Cardiology, “Ovidius” University of Constanta, Faculty of Medicine, Bucharest, Romania
| | - S. Onuc
- Department of Obstetrics and Gynecology, Constanta, “Ovidius” University of Constanta, Faculty of Medicine, Bucharest, Romania
| | - G. Neagoe
- “Hyperion” University - Department of Psychology, Bucharest, Romania
| | - V.I. Tica
- Department of Obstetrics and Gynecology, Constanta, “Ovidius” University of Constanta, Faculty of Medicine, Bucharest, Romania
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Enciu O, Toma EA, Badiu C, Miron A. A Close Encounter - Left Pneumonia and Pancreatic Tail Fistula after Laparoscopic Left Adrenalectomy. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:526-529. [PMID: 34084250 DOI: 10.4183/aeb.2020.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laparoscopic adrenalectomy is currently considered the gold standard for adrenal tumors up to 6 cm, and although with far less morbidity than the open alternative, when it comes to its complications we should not look away. The case concerns a 51-year old obese male that underwent left laparoscopic adrenalectomy for incidentaloma and developed pancreatic tail fistula. Without an evident pancreatic lesion during surgery and an uneventful early postoperative course the patient was discharged only to return 4 days later with respiratory symptoms and mild abdominal discomfort in the left upper quadrant. The CT scan diagnosed a left subphrenic fluid collection and left basal pneumonia, thus the patient underwent laparoscopic reintervention for drainage of the pancreatic fluid collection and received conventional antibiotherapy for pneumonia. The patient was discharged in good condition with the drainage tube in situ. The drainage tube was extracted 14 days later.
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Affiliation(s)
- O Enciu
- "Carol Davila" University of Medicine and Pharmacy - Surgery, Bucharest, Romania.,Elias University Emergency Hospital - Surgery, Bucharest, Romania
| | - E A Toma
- Infectious Diseases, Bucharest, Romania.,Elias University Emergency Hospital - Surgery, Bucharest, Romania
| | - C Badiu
- "C.I. Parhon" National Institute of Endocrinology - Thyroid Related Disorders, Bucharest, Romania
| | - A Miron
- "Carol Davila" University of Medicine and Pharmacy - Surgery, Bucharest, Romania.,Elias University Emergency Hospital - Surgery, Bucharest, Romania
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