Diagnosis and therapy for Cushing’s disease with negative dynamic MRI finding: a single‐centre experience

Sun, Yuhao; Sun, Qiang; Fan, Changyan; Shen, Jiankang; Zhao, Weiguo; Guo, Yan; Su, Tingwei; Wang, Weiqing; Ning, Guang; Bian, Liuguan

doi:10.1111/j.1365-2265.2011.04279.x

Cited by 29 publications

(27 citation statements)

References 48 publications

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“…Previous authors have also reported the lower remission rates we found with negative histology (15,20,22,41,42): this has been recently confirmed in a large study (15). Regarding imaging studies, we found no difference in remission rates between groups with negative or positive imaging, in concordance with both older and more recent studies that focused only on these two subgroups (43,44), as well as with most other previous studies (17,22,42). This is not especially surprising, as microadenomas are often not visible on MRI, whereas pituitary incidentalomas are found in 10% of the normal population (45).…”

Section: Remission Ratessupporting

confidence: 80%

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Alexandraki

Kaltsas

Isidori

et al. 2013

European Journal of Endocrinology

169

123

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Objective: To investigate the early and late outcomes of patients with Cushing's disease (CD) submitted to a neurosurgical procedure as first-line treatment. Design: In this single-centre retrospective case notes study, 131 patients with CD with a minimum follow-up period of 6 years (124 operated by transsphenoidal surgery (TSS) and seven by the transcranial approach) were studied. Apparent immediate cure: post-operative 0900 h serum cortisol level !50 nmol/l; remission: cortisol insufficiency or restoration of 'normal' cortisol levels with resolution of clinical features; and recurrence: dexamethasone resistance and relapse of hypercortisolaemic features. Results: In patients operated by TSS, remission of hypercortisolaemia was found in 72.8% of 103 microadenomas and 42.9% of 21 macroadenomas, with recurrence rates 22.7 and 33.3% respectively with a 15-year mean follow-up (range, 6-29 years). Of 27 patients with microadenomas operated after 1991, with positive imaging and pathology, 93% obtained remission with 12% recurrence. In multivariate analysis, the time needed to achieve recovery of hypothalamo-pituitary-adrenal axis was the only significant predictor of recurrence; all patients who recurred showed recovery within 3 years from surgery: 31.3% of patients had total hypophysectomy with no recurrence; 42% of patients with selective adenomectomy and 26.5% with hemi-hypophysectomy showed recurrence rates of 31 and 13% respectively (c 2 Z6.275, PZ0.03). Strict remission criteria were not superior in terms of the probability of recurrence compared with post-operative normocortisolaemia. Conclusions: Lifelong follow-up for patients with CD appears essential, particularly for patients who have shown rapid recovery of their axis. The strict criteria previously used for 'apparent cure' do not appear to necessarily predict a lower recurrence rate.

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Section: Remission Ratessupporting

confidence: 80%

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Alexandraki

Kaltsas

Isidori

et al. 2013

European Journal of Endocrinology

169

123

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“…Pituitary stalk interruption syndrome, first described as transection of PS in 1987, gets more recognition these years due to the fact that MRI is routinely performed in patients suspected of pituitary diseases. In our study involving 74 adult patients, the age at diagnosis was 25 (22)(23)(24)(25)(26)(27)(28) years, significantly older than 3Á6 years by Gascoin-Lachambre et al, 28 4Á0 years by Pinto et al 1 and 19Á7 years by Guo et al, 29 which made our population different than previously reported. We assumed atypical onset symptoms, negligence of short stature at early ages and insufficient understanding of the disease might attribute to this phenomenon to some extent.…”

Section: Discussioncontrasting

confidence: 70%

Relationship between pituitary stalk (PS) visibility and the severity of hormone deficiencies: PS interruption syndrome revisited

Wang

Jiang

et al. 2015

Clinical Endocrinology

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“…Although HC has been successfully used to treat keloids, it also induces certain adverse effects, such as arthralgia ( 39 ). In the present study, 9 small molecule drugs were identified by the CMAP database and acemetacin was predicted to be the most effective drug at reducing the adverse effects of HC.…”

Section: Discussionmentioning

confidence: 99%

Gene expression profiling analysis of keloids with and without hydrocortisone treatment

et al. 2017

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The present study aimed to investigate the genetic effects of hydrocortisone (HC) treatment on keloids and screen medicines to be used in a combination therapy of keloids with HC. The dataset GSE7890 was downloaded from Gene Expression Omnibus. It contained data regarding 4 fibroblast samples from normal scar tissue and 5 samples from keloid tissue with HC treatment, as well as 5 samples from normal scar and 5 samples from keloids without HC treatment. Following the identification of differentially expressed genes (DEGs), the functions of these DEGs were analyzed by Gene Ontology (GO) and pathway enrichment analyses. Furthermore, adverse effects of HC were identified using WebGestalt. Additionally, candidate small molecule drugs associated with keloids were selected from a connectivity map database. A total of 166 and 41 DEGs, with and without HC treatment respectively, were only present in dermal fibroblasts from keloids (termed genesets A and B, respectively). A set of 26 DEGs was present following both treatments (geneset C). A number of DEGs in geneset B (COL18A1 and JAG1) were associated with endothelial cell differentiation. However, in genesets A and C, certain genes (CCNB1 and CCNB2) were involved in the cell cycle and p53 signaling pathways, and a number of genes (IL1R1 and COL1A1) were associated with bone loss. Additionally, numerous small molecule drugs (including acemetacin) were associated with keloids. Thus, it has been determined that HC may treat keloids by targeting genes associated to endothelial cell differentiation (COL18A1 and JAG1). However, HC has a number of adverse effects, including bone loss. Acemetacin may be applied in a combination therapy, along with HC, to treat keloids.

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Diagnosis and therapy for Cushing’s disease with negative dynamic MRI finding: a single‐centre experience

Abstract: Based on the findings outlined, MRI-negative CD may be a surgically remediable syndrome, with a pathophysiological basis that primarily involves a pituitary cause of the hypercortisolaemia.

Cited by 29 publications

References 48 publications

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Relationship between pituitary stalk (PS) visibility and the severity of hormone deficiencies: PS interruption syndrome revisited

Gene expression profiling analysis of keloids with and without hydrocortisone treatment

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