Follow-up study on treatment in 27 patients with Cushing's disease: Adrenalectomy, transsphenoidal adenomectomy and medical treatment.

Tomita, Akio; Suzuki, Susumu; Hara, Iwao; Oiso, Yutaka; Mizuno, Shigeru; Yogo, Hiroshi; Kuwayama, Akio; Kageyama, Naoki

doi:10.1507/endocrj1954.28.197

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…Twelve studies include patients treated by laparoscopic adrenalectomy (412, 414 -418, 420, 423, 424, 426, 428, 429), 11 studies include patients treated by open adrenalectomy (402)(403)(404)(405)(406)(407)(408)(409)(410)(411)419), whereas five studies include patients treated by both a laparoscopic and an open adrenalectomy (413,421,422,425,427). Overall, in the studies involving only patients with CD, bilateral adrenalectomy is effective in controlling hormone excess and clinical syndrome in 78.9 -100% of patients (mean, 96.8%; median, 100%) (402-410, 412, 414 -425, 428, 429); disease persistence or recurrence was observed in 0 -12% of cases (mean, 1.7%; median, 0%) (402-410, 412, 414 -425, 428, 429), although Ͻ1% of these patients had clinical symptoms or signs of hypercortisolism (418,423).…”

Section: Bilateral Adrenalectomymentioning

confidence: 99%

“…Similar results have been reported in studies with the more selective serotonin antagonists ritanserine and ketanserine, which demonstrated a success rate of around 30% (607,608). Cyproheptadine, however, has been proposed to be more effective in cases of CD with a presumed hypothalamic origin (404). The main adverse effects were sedation and an increase in appetite (84,462,463).…”

Section: Neuromodulatory Drugsmentioning

confidence: 99%

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The Treatment of Cushing's Disease

et al. 2015

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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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Section: Bilateral Adrenalectomymentioning

confidence: 99%

Section: Neuromodulatory Drugsmentioning

confidence: 99%

The Treatment of Cushing's Disease

et al. 2015

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“…Although bilateral adrenalectomy had the advantage of curing hypercortisolaemia in virtually all patients, there was a significant mortality within the first year of 8% including a perioperative mortality of 3.8%. An early mortality of up to 25% appears in various published series (Sprague et al, 1961;Welbourn et al, 1971;Ernest & Ekman, 1972;Scott et al, 1977;Urbanic & George, 1981;Tomita et al, 1981;Skalkeas et al, 1982, Pelkonen et al, 1983. This perioperative mortality can now be minimized by preoperative preparation with metyrapone or other inhibitors of cortisol synthesis, together with advances in surgical and anaesthetic techniques including antibiotics.…”

Section: Discusionmentioning

confidence: 99%

The clinical response to treatment in adult Cushing's syndrome following remission of hypercortisolaemia

Ross

Linch

1985

Postgraduate Medical Journal

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Summary The clinical response of 57 adult patients with Cushing's syndrome due to bilateral adrenocortical hyperplasia or adrenocortical adenoma is documented following resolution of hypercortisolaemia by various forms of treatment. Despite satisfactory biochemical remission of the disease the clinical result was far less satisfactory when assessed by persistence of obesity (55%), menstrual irregularity (41%), hypertension (29%) and insulin-dependent diabetes (22%). Myopathy, hirsuitism and psychological abnormalities persisted to a lesser extent. The mortality rate of the series over a 30 year follow-up period was 4 times that of a general population matched for sex, age and year of entry into the series. Cardiovascular disease was the cause of death in 85%. Irreparable cardiovascular disease is produced early in the course of hypercortisolaemia, emphasizing the vital importance of the earliest possible recognition and treatment of this disease.

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“…Isolated case reports have showed long-term clinical and biochemical remission while on bromocriptine therapy in patients with ACTH-dependent Cushing's syndrome [40][41][42], while others have showed a lack of effect of this treatment [25,43]. In a small series of patients bromocriptine was effective in 2 patients and ineffective in 4 patients with Cushing's disease [26]. Some authors have reported successful results of bromocriptine treatment in patients with cyclic Cushing's disease [44][45][46][47] and reduction of pituitary tumor size [41].…”

Section: Clinical Applicationsmentioning

confidence: 98%

“…Some authors have suggested that in patients with Nelson's syndrome or previously treated Cushing's disease, cyproheptadine might decrease ACTH levels in up to 70% of the cases [10,23,24]. However this figure seems to be exaggerated, since some clinical reports have documented a remission of Cushing's disease [7,11,[15][16][17][18][19], whereas in others no significant effects were observed [25][26][27][28][29][30]. Cyproheptadine has been used in childhood to avoid pituitary surgery [17,30] and in Cushing's syndrome during pregnancy [31].…”

Section: Introductionmentioning

confidence: 99%