Etiology-, Sex-, and Tumor Size-Based Differences in Adrenocorticotropin-Dependent Cushing Syndrome

Walia, Rama; Dutta, Amitabh; Gupta, Nidhi; Bhansali, Anil; Pivonello, Rosario; Ahuja, Chirag; Dhandapani, Sivashanmugam; Dutta, Pinaki; Bhadada, Sanjay Kumar; Simeoli, Chiara; Hajela, Abhishek; Sachdeva, Naresh; Saikia, Uma Nahar

doi:10.1016/j.eprac.2020.11.014

Cited by 5 publications

(9 citation statements)

References 34 publications

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“…References from the hand search were all included in the electronic database searches. We reviewed 18 full-text papers for eligibility, and nine trials published between 1998 and 2021 met the inclusion criteria and were included in the systematic review [ 6 , 7 , 8 , 14 , 16 , 17 , 18 , 19 , 20 ]. We excluded trials with no available data on the biochemical profile of corticotroph microadenoma vs. macroadenoma.…”

Section: Resultsmentioning

confidence: 99%

“…A summary of trials included in the systematic review is shown in Table 3 . Of the included studies, four were conducted in Europe [ 6 , 8 , 14 , 19 ], two in the United States [ 7 , 17 ], two in Asia [ 9 , 20 ], and one study in Brazil [ 18 ]. The number of participants ranged from 7 to 74 patients with corticotroph macroadenoma [ 6 , 7 , 8 , 14 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the included studies, four were conducted in Europe [ 6 , 8 , 14 , 19 ], two in the United States [ 7 , 17 ], two in Asia [ 9 , 20 ], and one study in Brazil [ 18 ]. The number of participants ranged from 7 to 74 patients with corticotroph macroadenoma [ 6 , 7 , 8 , 14 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Data on UFC were not available in three studies [ 6 , 14 , 19 ], but five studies reporting on UFC showed no difference in levels between microadenoma and macroadenoma [ 7 , 8 , 16 , 17 , 19 ], and only Machado et al reported on significant difference in UFC, with higher levels reported for patients with microadenoma [ 18 ]. Four studies provided data on cortisol levels following 1 mg dexamethasone with no difference in all studies between microadenoma and macroadenoma [ 6 , 17 , 18 , 19 ].…”

Section: Resultsmentioning

confidence: 99%

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Clinical Study and Systematic Review of Pituitary Microadenomas vs. Macroadenomas in Cushing’s Disease: Does Size Matter?

Akirov

Shimon

Fleseriu

et al. 2022

JCM

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Background: Reports on clinical and biochemical differences between adrenocorticotropic hormone (ACTH)-secreting pituitary microadenomas and macroadenomas are limited and inconsistent. Objective: Compare clinical and biochemical characteristics of patients with corticotroph microadenomas and macroadenomas and assess predictive factors for biochemical response to dynamic testing for Cushing’s disease (CD) in a clinical trial and a systematic review. A second aim was to evaluate differences between macroadenomas with and without cavernous and sphenoid sinus invasion. Methods: Retrospective charts review of patients with CD, treated at Rabin Medical Center between 2000 and 2020 or at Maccabi Healthcare Services in Israel between 2005 and 2017. Clinical and biochemical factors were compared between patients with corticotroph microadenomas and macroadenomas. We have also performed a systematic review of all studies (PRISMA guidelines) comparing corticotroph microadenomas with macroadenomas up to November 31, 2021. Results: The cohort included 105 patients (82 women, 78%; mean age, 41.5 ± 14.5 years), including 80 microadenomas (mean size, 5.2 ± 2.2 mm) and 25 macroadenomas (mean size, 18.0 ± 7.7 mm). Other baseline characteristics were similar between groups. Most common presentation suggestive for hypercortisolemia among patients with both micro- and macroadenomas were weight gain (46.3% vs. 48.0%, p = NS) and Cushingoid features (27.5% vs. 20.0%, p = NS). Mean 24 h urinary free cortisol (5.2 ± 5.4 × ULN vs. 7.8 ± 8.7 × ULN) and serum cortisol following low-dose dexamethasone (372.0 ± 324.5 vs. 487.6 ± 329.8 nmol/L), though higher for macroadenomas, were not significant. Levels of ACTH were greater for macroadenomas (1.9 ± 1.2×ULN vs. 1.3 ± 0.8 × ULN, respectively, p = 0.01). Rates of recurrent/persistent disease were similar, as were rates of post-operative adrenal insufficiency and duration of post-operative glucocorticoid replacement. Macroadenomas with sphenoid or cavernous sinus invasion were associated with higher ACTH, 24 h free urinary cortisol, and serum cortisol following low-dose dexamethasone, compared with suprasellar or intrasellar macroadenomas. Conclusions: While ACTH-secreting macroadenomas exhibit higher plasma ACTH than microadenomas, there was no association between tumor size with cortisol hypersecretion or clinical features of hypercortisolemia. Though overall rare, increased awareness is needed for patients with CD with tumor extension in the cavernous or sphenoid sinus, which displays increased biochemical burden, highlighting that extent/location of the adenoma may be more important than size per se. Our systematic review, the first on this topic, highlights differences and similarities with our study.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Study and Systematic Review of Pituitary Microadenomas vs. Macroadenomas in Cushing’s Disease: Does Size Matter?

Akirov

Shimon

Fleseriu

et al. 2022

JCM

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“…There are several types of pituitary tumours with varied presentations and differing degrees of postoperative nursing issues (Das et al, 2020; Dutta et al, 2021; Gupta et al, 2018; Walia, Dutta, et al, 2021; Walia, Gupta, et al, 2021). The incidence of DI has been highly variable across literature, varying from as low as 4% to as high as 80% (Dumont et al, 2005; Hannon et al, 2012; Schreckinger et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of dietary diabetes insipidus bundle on the severity of postoperative fluid imbalance in pituitary region tumours: A randomized controlled trial

Koundal

Dhandapani

Thakur

et al. 2021

Journal of Advanced Nursing

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Aim To test the effectiveness of nurse‐led dietary diabetes insipidus (DI) bundle on the severity of postoperative fluid imbalance in pituitary region tumours. Design Blinded randomized controlled trial. Methods Patients aged 18–65 operated for sellar–suprasellar tumours in an Indian tertiary care centre were enrolled through total enumeration sampling and underwent randomization with allocation concealment during Sep 2018–Feb 2019. Pre‐operative DI, postoperative ventilation, renal failure or decompensated diabetes mellitus were excluded. Patients in the intervention group received a nurse‐led DI bundle (validated by three Delphi rounds) with four dietary components: intake of only water during thirst and avoidance of the following—added salt, high‐protein foods and caffeinated drinks. Treating clinicians and the investigator assessing outcome were blinded about enrolment. Urine output, serum sodium, vasopressin requirement and hospital stay were assessed as primary outcomes. The outcome measures were monitored daily till the 6th postoperative day. Analyses were performed on ‘intention‐to‐treat’ basis, irrespective of compliance. Independent t‐test and Chi‐square test were used. Results Of the initial 63 patients, 50 fulfilling criteria were randomized to two groups and assessed over six days yielding 150 patient‐days per group. There were no significant baseline differences between groups. The mean daily urine output was significantly lower in the DI bundle group than in control, both overall and among endonasal operated pituitary adenomas [3000.09(462.7) vs. 4095.71(896.4)ml & 2987.14(419.5) vs. 4064.73(1051)ml], with the greatest difference on the second postoperative day. Though hypernatraemia in controls became most prominent during days 2–3 and resolved in a week, it was significantly lower in the intervention group (12.7% vs. 30.7% overall, 11.4% vs. 29.4% endonasal adenomas). The need for vasopressin analogues and hospital stay were also significantly lower with DI bundle (p < 0.001). Conclusion This is probably the first ever report of dietary DI bundle among operated pituitary patients, which seem to flatten the DI trend with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. Trial registration CTRI/2018/07/015127 of ICMR. Impact The nurse‐led dietary DI bundle has effectively reduced the severity of DI among operated pituitary patients with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. Its implementation is simple and easy to carry out, especially in resource‐constrained institutions, where continuous monitoring and repeated serum sodium estimation are difficult.

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Sex und Gender in der Endokrinologie

Regitz-Zagrosek

2023

Gendermedizin in Der Klinischen Praxis

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Etiology-, Sex-, and Tumor Size-Based Differences in Adrenocorticotropin-Dependent Cushing Syndrome

Cited by 5 publications

References 34 publications

Clinical Study and Systematic Review of Pituitary Microadenomas vs. Macroadenomas in Cushing’s Disease: Does Size Matter?

Clinical Study and Systematic Review of Pituitary Microadenomas vs. Macroadenomas in Cushing’s Disease: Does Size Matter?

Effectiveness of dietary diabetes insipidus bundle on the severity of postoperative fluid imbalance in pituitary region tumours: A randomized controlled trial

Sex und Gender in der Endokrinologie

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