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Scholz P, Altay L, Sitnilska V, van Dijk EHC, Pereira AM, van Haalen FM, Akhtar I, Boon CJF, Fauser S. SALIVARY ALPHA-AMYLASE LEVELS MAY CORRELATE WITH CENTRAL SEROUS CHORIORETINOPATHY ACTIVITY. Retina 2021; 41:2479-2484. [PMID: 34292222 DOI: 10.1097/iae.0000000000003266] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate and compare the salivary alpha-amylase (sAA) activity as an indicator of the sympathetic activity and stress response in patients with central serous chorioretinopathy (CSC) and healthy control subjects. METHODS Prospective multicenter case series, including 80 CSC patients and 88 healthy control subjects. Central serous chorioretinopathy status was classified as either active or inactive, depending on the presence of subretinal fluid on optical coherence tomography. Salivary samples were collected in the morning from patients and control subjects of the main cohort and at midnight for the additional cohort. Salivary alpha-amylase activity was determined in all patients and control subjects. RESULTS Morning sAA activity was significantly higher in patients with active CSC compared with inactive CSC (P = 0.049) and to healthy control subjects (P = 0.012). There was no significant difference in sAA activity between patients with inactive CSC and control subjects (P = 1.0). Nocturnal sAA activity did not show any significant difference between patients with active CSC and either inactive CSC or control subjects (P = 0.139). CONCLUSION Morning sAA activity is increased in patients with active CSC, although diurnal rhythmicity is preserved. Measurement of sAA is easy to perform and might be an eligible tool to further investigate the relation between stress and CSC.
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Affiliation(s)
- Paula Scholz
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Lebriz Altay
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Vasilena Sitnilska
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
| | - Femke M van Haalen
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
| | - Isha Akhtar
- Department of Ophthalmology, University of Cologne, Experimental Immunology of the Eye, Cologne, Germany
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
- Department of Ophthalmology, Academic Medical Center, Amsterdam, the Netherlands; and
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
- F. Hoffmann-La Roche, Basel, Switzerland
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Broersen LHA, van Haalen FM, Kienitz T, Dekkers OM, Strasburger CJ, Pereira AM, Biermasz NR. The incidence of adrenal crisis in the postoperative period of HPA axis insufficiency after surgical treatment for Cushing's syndrome. Eur J Endocrinol 2019; 181:201-210. [PMID: 31167165 DOI: 10.1530/eje-19-0202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/05/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adrenal crisis, the most feared complication of adrenal insufficiency, is a potentially life-threatening state of acute glucocorticoid deficiency. After successful surgery for Cushing's syndrome, many patients develop (transient) adrenal insufficiency. The incidence of adrenal crisis in patients treated for hypercortisolism is unknown. METHODS Cohort study included consecutive patients with Cushing's syndrome with adrenal insufficiency after surgery from Leiden and Berlin from 2000 to 2015. We summarized the incidence of adrenal crisis, compared patients with and without adrenal crisis regarding potential risk factors for its occurrence and assessed the effect of better education in time on incidence of adrenal crisis. RESULTS We included 106 patients, of whom 19 patients had a total of 41 adrenal crises. There were 9.0 crises per 100 patient-years at risk (95% confidence interval (CI): 6.7-12.0). All crises occurred while on hydrocortisone replacement. The risk ratio for a recurrent crisis was 2.3 (95% CI: 1.2-4.6). No clear change in incidence of adrenal crisis due to better education in time was observed. There was no difference in recurrence rate between patients with, and without any crisis, but patients with adrenal crisis had more often pituitary deficiencies. CONCLUSIONS The incidence of adrenal crises after treatment for Cushing's syndrome is substantial, and patients who suffered from an adrenal crisis have higher risk for recurrent crisis. Adrenal crisis tends to present early after remission of Cushing's syndrome, which is probably the period of severest HPA axis suppression, despite in general higher hydrocortisone replacement doses for withdrawal complaints in this period. Additional pituitary hormone deficiencies may be a risk marker for increased risk of adrenal crisis. However, further risk factor analysis is needed to identify risks for a first crisis. Effective education methods to prevent adrenal crises should be identified and implemented, including stress instructions by trained nursing staff before hospital discharge.
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Affiliation(s)
- Leonie H A Broersen
- Department of Medicine, Division of Endocrinology
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Department of Endocrinology, Diabetes and Nutrition, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Femke M van Haalen
- Department of Medicine, Division of Endocrinology
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Tina Kienitz
- Department of Endocrinology, Diabetes and Nutrition, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian J Strasburger
- Department of Endocrinology, Diabetes and Nutrition, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
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Broersen LHA, van Haalen FM, Biermasz NR, Lobatto DJ, Verstegen MJT, van Furth WR, Dekkers OM, Pereira AM. Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for Cushing's disease: surgical outcome, mortality, and complications. Orphanet J Rare Dis 2019; 14:64. [PMID: 30866993 PMCID: PMC6416951 DOI: 10.1186/s13023-019-1038-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background First-choice treatment for Cushing’s disease is transsphenoidal adenomectomy. Since its introduction in the 1970s, many centers have now switched from microscopic to endoscopic surgery. We compared both techniques for the treatment of Cushing’s disease at the Leiden University Medical Center, a European reference center for pituitary diseases. Methods Cohort study with inclusion and follow-up of consecutive Cushing’s disease patients primarily treated by transsphenoidal surgery at the Leiden University Medical Center between 1978 and 2016. We compared remission rates (primary endpoint), mortality, and complications between microscopic (performed up to 2005) and endoscopic (performed from 2003 onwards) surgery. Subgroup analyses were performed by tumor size, surgical experience, and preoperative imaging techniques. Additionally, surgeons’ intraoperative findings regarding presence and removal of the adenoma were related to surgical outcome. Results Of 137 included patients, 87 were treated microscopically and 50 endoscopically. Three months after microscopic surgery, 74 patients (86%) were in remission. Five-year recurrence-free survival was 89% (95% confidence interval [CI]: 82–96%), and ten-year recurrence free survival was 84% (95% CI: 75–93%). After endoscopic surgery, 39 patients (83%) were in remission. Both five-year and ten-year recurrence-free survival were 71% (95% CI: 55–87%). Hazard ratio for recurrence was 0.47 (95% CI: 0.19–1.14), and for mortality 2.79 (95% CI: 0.35–22.51), for microscopic versus endoscopic surgery. No learning curve was found for endoscopy, nor an influence of preoperative imaging technique for microscopy. In addition, we did not find a clear relation between the surgeons’ intraoperative findings and surgical outcomes. Conclusions This study did not identify a clear advantage of microscopic or endoscopic transsphenoidal surgery for the treatment of Cushing’s disease based on clinical outcome. The transition to endoscopic surgery at our center was not accompanied by transient worsening of outcomes, which may be reassuring for those considering transitioning.
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Affiliation(s)
- Leonie H A Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Femke M van Haalen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Daniel J Lobatto
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Marco J T Verstegen
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Wouter R van Furth
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Broersen LHA, van Haalen FM, Kienitz T, Biermasz NR, Strasburger CJ, Dekkers OM, Pereira AM. Sex Differences in Presentation but Not in Outcome for ACTH-Dependent Cushing's Syndrome. Front Endocrinol (Lausanne) 2019; 10:580. [PMID: 31543864 PMCID: PMC6730597 DOI: 10.3389/fendo.2019.00580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/08/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Sex differences in clinical picture of ACTH-dependent Cushing's syndrome are controversial, except for the known higher prevalence in females. We compared a broad range of potential differences to enable a more accurate understanding of the clinical picture of sex-specific ACTH-dependent Cushing's syndrome. Methods: Cohort study including consecutive patients with ACTH-dependent Cushing's syndrome from Leiden and Berlin diagnosed between 2000 and 2016. We compared clinical presentation, biochemical parameters, diagnostic tests, surgical outcome, and comorbidities between men and women. Results: We included 130 patients: 37 males and 93 females. With similar cortisol concentrations, ACTH concentrations were higher in males than females at time of diagnosis (median: 116 vs. 57 ng/L). The prevalence of osteoporosis was higher in males than in females (48.6 vs. 25.0%), persisting after surgery, with more vertebral fractures (16.2 vs. 5.4%) before surgery. Males showed more anemia (75.9 vs. 36.8%) after surgery. There were no differences in etiology, pituitary tumor size, diagnostic and therapeutic strategy, or surgical outcome between sexes. Conclusions: Based on this study, males and females with ACTH-dependent Cushing's syndrome present different clinical patterns. However, these differences do not justify different diagnostic strategies or treatment based on sex, considering the similar surgical outcome. Clinicians should be alert to diagnose accompanying osteoporosis (with fractures) in male patients with ACTH-dependent Cushing's syndrome.
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Affiliation(s)
- Leonie H. A. Broersen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, Netherlands
- Department of Endocrinology, Diabetes and Nutrition, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- *Correspondence: Leonie H. A. Broersen
| | - Femke M. van Haalen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, Netherlands
| | - Tina Kienitz
- Department of Endocrinology, Diabetes and Nutrition, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nienke R. Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, Netherlands
| | - Cristian J. Strasburger
- Department of Endocrinology, Diabetes and Nutrition, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Olaf M. Dekkers
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Alberto M. Pereira
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, Netherlands
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van Haalen FM, van Dijk EHC, Dekkers OM, Bizino MB, Dijkman G, Biermasz NR, Boon CJF, Pereira AM. Cushing's Syndrome and Hypothalamic-Pituitary-Adrenal Axis Hyperactivity in Chronic Central Serous Chorioretinopathy. Front Endocrinol (Lausanne) 2018; 9:39. [PMID: 29515517 PMCID: PMC5826300 DOI: 10.3389/fendo.2018.00039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Central serous chorioretinopathy (CSC), a specific form of macular degeneration, has been reported as presenting manifestation of Cushing's syndrome. Furthermore, CSC has been associated with both exogenous hypercortisolism and endogenous Cushing's syndrome. It is important to know whether CSC patients should be screened for Cushing's syndrome. Although hypothalamic-pituitary-adrenal (HPA) axis hyperactivity in CSC has been suggested, no detailed evaluation of the HPA axis has been performed in a large cohort of CSC patients. This study aimed to investigate whether Cushing's syndrome prevalence is increased among chronic CSC (cCSC) patients and whether detailed endocrinological phenotyping indicates hyperactivity of the HPA axis. DESIGN Cross-sectional study. PATIENTS 86 cCSC patients and 24 controls. MEASUREMENTS Prevalence of Cushing's syndrome, HPA axis activity. RESULTS None of the cCSC patients met the clinical or biochemical criteria of Cushing's syndrome. However, compared to controls, HPA axis activity was increased in cCSC patients, reflected by higher 24 h urinary free cortisol, and accompanying higher waist circumference and diastolic blood pressure, whereas circadian cortisol rhythm and feedback were not different. Chronic CSC patients did not report more stress or stress-related problems on questionnaires. CONCLUSION No case of Cushing's syndrome was revealed in a large cohort of cCSC patients. Therefore, we advise against screening for Cushing's syndrome in CSC patients, unless additional clinical features are present. However, our results indicate that cCSC is associated with hyperactivity of the HPA axis, albeit not accompanied with perception of more psychosocial stress.
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Affiliation(s)
- Femke M. van Haalen
- Center for Endocrine Tumors, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Femke M. van Haalen,
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf M. Dekkers
- Center for Endocrine Tumors, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Maurice B. Bizino
- Center for Endocrine Tumors, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Greet Dijkman
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Nienke R. Biermasz
- Center for Endocrine Tumors, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Camiel J. F. Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Alberto M. Pereira
- Center for Endocrine Tumors, Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands
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Andela CD, van Haalen FM, Ragnarsson O, Papakokkinou E, Johannsson G, Santos A, Webb SM, Biermasz NR, van der Wee NJA, Pereira AM. MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies. Eur J Endocrinol 2015; 173:R1-14. [PMID: 25650405 DOI: 10.1530/eje-14-1101] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/03/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cushing's syndrome (CS) is characterized by excessive exposure to cortisol, and is associated with both metabolic and behavioral abnormalities. Symptoms improve substantially after biochemical cure, but may persist during long-term remission. The causes for persistent morbidity are probably multi-factorial, including a profound effect of cortisol excess on the brain, a major target area for glucocorticoids. OBJECTIVE To review publications evaluating brain characteristics in patients with CS using magnetic resonance imaging (MRI). METHODS Systematic review of literature published in PubMed, Embase, Web of Knowledge, and Cochrane databases. RESULTS Nineteen studies using MRI in patients with CS were selected, including studies in patients with active disease, patients in long-term remission, and longitudinal studies, covering a total of 339 unique patients. Patients with active disease showed smaller hippocampal volumes, enlarged ventricles, and cerebral atrophy as well as alterations in neurochemical concentrations and functional activity. After abrogation of cortisol excess, the reversibility of structural and neurochemical alterations was incomplete after long-term remission. MRI findings were related to clinical characteristics (i.e., cortisol levels, duration of exposure to hypercortisolism, current age, age at diagnosis, and triglyceride levels) and behavioral outcome (i.e., cognitive and emotional functioning, mood, and quality of life). CONCLUSION Patients with active CS demonstrate brain abnormalities, which only partly recover after biochemical cure, because these still occur even after long-term remission. CS might be considered as a human model of nature that provides a keyhole perspective of the neurotoxic effects of exogenous glucocorticoids on the brain.
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Affiliation(s)
- Cornelie D Andela
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Femke M van Haalen
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Oskar Ragnarsson
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Eleni Papakokkinou
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Gudmundur Johannsson
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Alicia Santos
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Susan M Webb
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands Department of MedicineDivision of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The NetherlandsLeiden Institute for Brain and CognitionLeiden, The NetherlandsDepartment of Endocrinology Diabetes and MetabolismSahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenEndocrinology/Medicine DepartmentsHospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, SpainDepartment of PsychiatryLeiden University Medical Center, Leiden, The Netherlands
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van Haalen FM, Broersen LHA, Jorgensen JO, Pereira AM, Dekkers OM. Management of endocrine disease: Mortality remains increased in Cushing's disease despite biochemical remission: a systematic review and meta-analysis. Eur J Endocrinol 2015; 172:R143-9. [PMID: 25722097 DOI: 10.1530/eje-14-0556] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this systematic review and meta-analysis was to investigate whether mortality is increased in patients biochemically cured after initial treatment for Cushing's disease. This is a systematic review and meta-analysis of follow-up studies in patients cured from Cushing's disease after initial treatment was performed. Eight electronic databases were searched from 1975 to March 2014 to identify potentially relevant articles. Original articles reporting the standardized mortality ratio (SMR) for patients cured of Cushing's disease were eligible for inclusion. SMRs were pooled in a random effects model. I(2) statistics was used for quantification of heterogeneity. Eight cohort studies with a total of 766 patients were included. Out of eight studies, seven showed an SMR above 1.0 for cured patients. The pooled SMR was 2.5 (95% CI 1.4-4.2). The I(2) statistics showed evidence for statistical heterogeneity (78%, Q-statistics P<0.001), which was largely explained by two outliers. This meta-analysis reveals that mortality remains increased in patients with Cushing's disease even after initial biochemical cure remission, suggesting that cure does not directly reverse the metabolic consequences of long-term overexposure to cortisol. Other conditions such as hypopituitarism, including persistent adrenocortical insufficiency after surgery, may also contribute to the increased mortality risk.
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Affiliation(s)
- Femke M van Haalen
- Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark
| | - Leonie H A Broersen
- Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark
| | - Jens O Jorgensen
- Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark
| | - Alberto M Pereira
- Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark
| | - Olaf M Dekkers
- Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark
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