Quality of life impairment after a diagnosis of Cushing’s syndrome

Webb, Susan M.; Valassi, Elena

doi:10.1007/s11102-022-01245-9

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…Cortisol excess contributes to impaired quality of life in PA sufferers through multiple co-morbidities, including depression/anxiety [ 65 , 66 , 67 , 68 , 69 , 70 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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Connshing syndrome (CoSh) (adrenal-related synchronous aldosterone (A) and cortisol (C) excess) represents a distinct entity among PA (primary hyperaldosteronisms) named by W. Arlt et al. in 2017, but the condition has been studied for more than 4 decades. Within the last few years, this is one of the most dynamic topics in hormonally active adrenal lesions due to massive advances in steroids metabolomics, molecular genetics from CYP11B1/B2 immunostaining to genes constellations, as well as newly designated pathological categories according to the 2022 WHO classification. In gross, PA causes 4–10% of all high blood pressure (HBP) cases, and 20% of resistant HBP; subclinical Cushing syndrome (SCS) is identified in one-third of adrenal incidentalomas (AI), while CoSh accounts for 20–30% to 77% of PA subjects, depending on the tests used to confirm autonomous C secretion (ACS). The clinical picture overlaps with PA, hypercortisolemia being mild. ACS is suspected in PA if a more severe glucose and cardiovascular profile is identified, or there are larger tumours, ACS being an independent factor risk for kidney damage, and probably also for depression/anxiety and osteoporotic fractures. It seems that one-third of the PA-ACS group harbours mutations of C-related lines like PRKACA and GNAS. A novel approach means we should perform CYP11B2/CYP11B1 immunostaining; sometimes negative aldosteronoma for CYP11B1 is surrounded by micronodules or cell clusters with positive CYP11B1 to sustain the C excess. Pitfalls of hormonal assessments in CoSh include the index of suspicion (check for ACS in PA patients) and the interpretation of A/C ratio during adrenal venous sample. Laparoscopic adrenalectomy is the treatment of choice. Post-operative clinical remission rate is lower in CoSh than PA. The risk of clinically manifested adrenal insufficiency is low, but a synthetic ACTH stimulating testing might help to avoid unnecessary exposure to glucocorticoids therapy. Finally, postponing the choice of surgery may impair the outcome, having noted that long-term therapy with mineralocorticoids receptors antagonists might not act against excessive amounts of C. Awareness of CoSh improves management and overall prognosis.

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“…Cortisol excess contributes to impaired quality of life in PA sufferers through multiple co-morbidities, including depression/anxiety [ 65 , 66 , 67 , 68 , 69 , 70 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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“…Finally, many patients develop recognizable psychiatric diseases; notably, depression [ 75 ]. Advanced ACC patients hold many additional organic risk factors that increase the risk of the onset of depression; in particular, metabolic and endocrine alterations, especially in cortisol-secreting ACC [ 76 ], and the results of oncological treatments [ 75 ]. Moreover, chronic pain and disability resulting from extensive surgical interventions may represent further factors that ignite depression [ 76 , 77 , 78 ].…”

Section: Symptom Managementmentioning

confidence: 99%

“…Advanced ACC patients hold many additional organic risk factors that increase the risk of the onset of depression; in particular, metabolic and endocrine alterations, especially in cortisol-secreting ACC [ 76 ], and the results of oncological treatments [ 75 ]. Moreover, chronic pain and disability resulting from extensive surgical interventions may represent further factors that ignite depression [ 76 , 77 , 78 ]. Patients who have pre-existing psychiatric disorders should be closely monitored after a cancer diagnosis because they demonstrate a higher rate of depression relapse [ 79 ].…”

Section: Symptom Managementmentioning

confidence: 99%

Advanced Adrenocortical Carcinoma: From Symptoms Control to Palliative Care

Ruggiero

Tizianel

Caccese

et al. 2022

Cancers

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The prognosis of patients with advanced adrenocortical carcinoma (ACC) is often poor: in the case of metastatic disease, five-year survival is reduced. Advanced disease is not a non-curable disease and, in referral centers, the multidisciplinary approach is the standard of care: if a shared decision regarding several treatments is available, including the correct timing for the performance of each one, overall survival is increased. However, many patients with advanced ACC experience severe psychological and physical symptoms secondary to the disease and the cancer treatments. These symptoms, combined with existential issues, debase the quality of the remaining life. Recent strong evidence from cancer research supports the early integration of palliative care principles and skills into the advanced cancer patient’s trajectory, even when asymptomatic. A patient with ACC risks quickly suffering from symptoms/effects alongside the disease; therefore, early palliative care, in some cases concurrent with oncological treatment (simultaneous care), is suggested. The aims of this paper are to review current, advanced ACC approaches, highlight appropriate forms of ACC symptom management and suggest when and how palliative care can be incorporated into the ACC standard of care.

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“…In hypercortisolism (HC), hypercortisolemia causes metabolic disturbances in various organs of the body, resulting in clinical manifestations, 1 of which is muscle weakness 1 . In humans with HC, muscle atrophy, and IM fatty infiltration associated with hypercortisolemia lead to muscle weakness 2,3 . Moreover, skeletal muscles not only control body movement but also play a role in energy expenditure; homeostasis of glucose, lipids, and amino acids; inflammatory responses; and, immune mechanisms, all of which have an effect on prognosis, either alone or in combination with other conditions 4 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of muscle mass and intramuscular fatty infiltration in dogs with hypercortisolism and their association with prognosis

Yoshida,

Kobatake,

Takashima

et al. 2024

Veterinary Internal Medicne

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BackgroundMuscle atrophy and intramuscular fatty infiltration, as well as their association with prognosis, have not been quantified in dogs with spontaneous hypercortisolism (HC).ObjectiveTo quantitatively evaluate muscle atrophy and IM fatty infiltration in dogs with HC and determine their prognostic impact.AnimalsFifty‐three dogs with HC and 66 control dogs without HC.MethodsRetrospective cohort study. Medical records and computed tomography images obtained between 2014 and 2021 were evaluated. Kaplan‐Meier curves and log‐rank tests were used to analyze the effect of muscle atrophy and IM fatty infiltration on the prognosis of dogs with HC.ResultsDogs with HC showed lower visually measured cross‐sectional area (VCSA) and cross‐sectional area based on attenuation (HCSA) than control dogs (median [interquartile range {IQR}]: 50.3 mm2/mm [36.2‐67.8] vs 66.7 mm2/mm [48.0‐85.9]; P < .001; 30.4 mm2/mm [13.7‐57.2] vs 54.8 mm2/mm [39.7‐71.5]; P < .001, respectively). Dogs with HC had lower epaxial muscle attenuation (L3HU) than control dogs (median [IQR]: 21.2 Hounsfield [HU] [12.4‐28.2] vs 33.2 HU [22.6‐43.6]; P < .001). Dogs with HC with lower HCSA or L3HU had shorter survival (median [IQR]: 670 days [222‐673] vs 949 days [788‐1074], P < .01; 523 days [132‐670] vs 949 days [756‐1074], P < .01, respectively) but not lower VCSA (median [IQR]: 673 days [132‐788] vs 949 days [523 to not applicable]; P = .30).Conclusion and Clinical ImportanceHypercortisolism in dogs causes muscle atrophy and IM fatty infiltration and is associated with poor prognosis.

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Quality of life impairment after a diagnosis of Cushing’s syndrome

Cited by 12 publications

References 17 publications

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Advanced Adrenocortical Carcinoma: From Symptoms Control to Palliative Care

Evaluation of muscle mass and intramuscular fatty infiltration in dogs with hypercortisolism and their association with prognosis

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