Postsurgical Recurrent Cushing Disease: Clinical Benefit of Early Intervention in Patients with Normal Urinary Free Cortisol

Carroll, Ty B.; Javorsky, Bradley R.; Findling, James W.

doi:10.4158/ep161380.or

Cited by 36 publications

(21 citation statements)

References 27 publications

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“…This chart review showed biochemical control and overall symptomatic improvement exhibited by all patients that varied over the course of long-term treatment. It also supports previous studies in the literature that highlight the importance of an early diagnosis of recurrence, thus improving the chances of control; elevated late-night salivary cortisol levels are an early biochemical marker of recurrent CD ( 5 , 13 , 14 ). Most patients experienced hyperglycemia, which was controlled by prescribed concomitant antidiabetic medication and periodic monitoring of the associated changes.…”

Section: Discussionsupporting

confidence: 89%

Medical Therapy with Pasireotide in Recurrent Cushing’s Disease: Experience of Patients Treated for At Least 1 Year at a Single Center

et al. 2017

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Subcutaneous (SC) injection of pasireotide, a somatostatin analog, is approved for the treatment of adults with Cushing’s disease (CD) for whom pituitary surgery was unsuccessful or is not an option. We highlight the symptomatic and biochemical improvement of six patients with recurrent CD treated with pasireotide SC at a single center for at least 1 year. Patients were treated either through commercial use (n = 5) or through the Phase 3 trial (n = 1; identifier, NCT00434148; study number, B2305). Most patients (n = 5) were female, and the mean age at diagnosis was 35.8 years. All patients demonstrated biochemical control at 1 year of treatment. Three of the five real-world patients followed for more than 1 year remain on pasireotide SC and are controlled. Two patients discontinued pasireotide SC; one patient because of persistently elevated urinary-free cortisol levels and gallstones, and the other because of treatment for an unrelated brain tumor. Symptomatic improvement varied, but all patients demonstrated weight loss. Nausea and mild, transient injection-site reactions were the most frequently reported adverse events. Although glycated hemoglobin (HbA1c) increased after treatment initiation, four of five patients maintained HbA1c levels ≤7.0% while receiving pasireotide SC and concomitant individualized diabetes medication, if necessary. In patients who discontinued pasireotide SC, HbA1c levels decreased within 6 weeks. This report documents real-world use of pasireotide SC and indicates its effectiveness as a long-term treatment option for patients with CD. Although hyperglycemia was observed in most patients, it was managed with appropriate monitoring and treatment and was reversible upon discontinuation of pasireotide SC.

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Section: Discussionsupporting

confidence: 89%

Medical Therapy with Pasireotide in Recurrent Cushing’s Disease: Experience of Patients Treated for At Least 1 Year at a Single Center

et al. 2017

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“…Carroll et al showed in a study with 15 patients that patients benefit from early initiation of second-line treatments in terms of weight-loss, improvement of hypertension and Hba1c, and improved quality of life, respectively. Of the 15 patients, 12 had normal UFC at time of recurrence, whereas the 1 mg dexamethasone suppression test was abnormal in 11 of 15, and 14 had abnormal late night salivary cortisol levels [90].…”

Section: Treatment Recommendations In Biochemical and Clinical Mild Rmentioning

confidence: 98%

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

et al. 2020

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Purpose Recurrence after pituitary surgery in Cushing’s disease (CD) is a common problem ranging from 5% (minimum) to 50% (maximum) after initially successful surgery, respectively. In this review, we give an overview of the current literature regarding prevalence, diagnosis, and therapeutic options of recurrent CD. Methods We systematically screened the literature regarding recurrent and persistent Cushing’s disease using the MESH term Cushing’s disease and recurrence. Of 717 results in PubMed, all manuscripts in English and German published between 1980 and April 2020 were screened. Case reports, comments, publications focusing on pediatric CD or CD in veterinary disciplines or studies with very small sample size (patient number < 10) were excluded. Also, papers on CD in pregnancy were not included in this review. Results and conclusions Because of the high incidence of recurrence in CD, annual clinical and biochemical follow-up is paramount. 50% of recurrences occur during the first 50 months after first surgery. In case of recurrence, treatment options include second surgery, pituitary radiation, targeted medical therapy to control hypercortisolism, and bilateral adrenalectomy. Success rates of all these treatment options vary between 25 (some of the medical therapy) and 100% (bilateral adrenalectomy). All treatment options have specific advantages, limitations, and side effects. Therefore, treatment decisions have to be individualized according to the specific needs of the patient.

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“… Biomarker What does it measure? Salivary cortisol (morning) Elevated cortisol levels have been shown to predict stress, depression and Cushing’s syndrome ( Carroll et al, 2016 ; Hellhammer et al, 2009 ; Owens et al, 2014 ). Salivary cortisol (morning – afternoon) A slower decrease in cortisol levels through out the day (flatter diurnal cortisol slopes) is an indicator of high levels of stress and is associated with health conditions such as depression, fatigue, cardiovascular disease and type II diabetes ( Adam et al, 2017 ; Bower et al, 2005 ; Doane et al, 2013 ; Hackett et al, 2016 ; Kumari et al, 2009 ; Matthews et al, 2006 ).…”

Section: Appendix Amentioning

confidence: 99%

Going beyond the mean in examining relationships of adolescent non-cognitive skills with health-related quality of life and biomarkers in later-life

Atkins

Turner

Chandola

et al. 2020

Economics & Human Biology

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Highlights We examined the association between adolescent non-cognitive skills and adult health, using both subjective and objective measures of health. Conscientiousness is positively associated with your ability to cope with stress and negatively associated with cardiovascular risk. Agreeableness is positively associated with health-related quality of life and negatively associated with physiological ‘wear and tear’, however is negatively associated with your ability to cope with stress. Neuroticism is negatively associated with health-related quality of life, and positively associated with physiological ‘wear and tear’ and cardiovascular risk. All of these associations are stronger at the end of the health distribution that indicates poorer health, except for the cardiovascular risk biomarkers.

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Postsurgical Recurrent Cushing Disease: Clinical Benefit of Early Intervention in Patients with Normal Urinary Free Cortisol

Cited by 36 publications

References 27 publications

Medical Therapy with Pasireotide in Recurrent Cushing’s Disease: Experience of Patients Treated for At Least 1 Year at a Single Center

Medical Therapy with Pasireotide in Recurrent Cushing’s Disease: Experience of Patients Treated for At Least 1 Year at a Single Center

Recurrence after pituitary surgery in adult Cushing’s disease: a systematic review on diagnosis and treatment

Going beyond the mean in examining relationships of adolescent non-cognitive skills with health-related quality of life and biomarkers in later-life

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