Signs, symptoms and biochemistry in recurrent Cushing disease: a prospective pilot study

Braun, Leah; Zopp, Stephanie; Vogel, Frederick; Honegger, Jürgen; Rubinstein, German; Schilbach, Katharina; Künzel, Heike; Beuschlein, Felix; Reincke, Martín

doi:10.1007/s12020-021-02719-9

Cited by 3 publications

(4 citation statements)

References 19 publications

(21 reference statements)

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“…Overweight is common at diagnosis (up to 80%), a severe obesity is seldom Stachowska 2020 39 Braun 2021 40 Lacroix 2020 41 Ceccato 2018 42 Reversible after cure of disease Medical therapy with pasireotide and metyrapone leads also to weigh reduction One of the first symptoms of recurrence Comorbidities, which often persist Myopathy 40%-80% of patients are affected Berr 2017 32 Müller 2019 33 Vogel 2020 27 Vogel 2021 34 Persists over the long-term In the first…”

Section: Overweightmentioning

confidence: 99%

“…39 Weight gain is also one of the first symptoms of recurrence. 40 After curative surgery, most patients lose weight very quickly. However, detailed studies on the dynamics and to what extent patients lose weight are lacking.…”

Section: Obesitymentioning

confidence: 99%

“…Patients with CS often suffer from weight gain and are overweight (up to 80%) 39 . Weight gain is also one of the first symptoms of recurrence 40 . After curative surgery, most patients lose weight very quickly.…”

Section: Frequency and Management Of Selected Comorbiditiesmentioning

confidence: 99%

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Long‐term morbidity and mortality in patients with Cushing's syndrome

Braun

Vogel

Reincke

2022

J Neuroendocrinology

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Increased multisystem morbidity and mortality in patients with Cushing's syndrome comprise clinical problems and challenges, both at the time of diagnosis and in remission. Relevant comorbidities and clinical problems include hypertension, diabetes, overweight, myopathy and a high risk for acute complications such as infections and venous thrombembolism. Although there are therapy recommendations for most of these comorbidities, there is a lack of large, prospective studies to confirm and optimise them. Mortality is especially high during active disease and within the first year after diagnosis, as a result of cardiovascular events, infections and suicide. All in all, interdisciplinary therapy management is important for reducing morbidity and mortality over the long‐term.

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Section: Overweightmentioning

confidence: 99%

Section: Obesitymentioning

confidence: 99%

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Long‐term morbidity and mortality in patients with Cushing's syndrome

Braun

Vogel

Reincke

2022

J Neuroendocrinology

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“…The diagnosis of CS was confirmed by surgery (histology, adrenal insufficiency after surgery, and clinical improvement). We defined successful surgery leading to remission as a phase of adrenal insufficiency post-surgery, requiring glucocorticoid replacement therapy, and a regression of clinical symptoms (23). Patients were examined 1, 3, 6, and 12 months after surgery and annually thereafter (checklist-based clinical examination, recording of new or worsening comorbidities combined with biochemical testing by 1-mg LDDST, UFC, and LNSC).…”

Section: Introductionmentioning

confidence: 99%

E47 as a novel glucocorticoid-dependent gene mediating lipid metabolism in patients with endogenous glucocorticoid excess

Zhang,

Nowotny,

Theodoropoulou

et al. 2023

Front. Endocrinol.

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PurposeE47 has been identified as a modulating transcription factor of glucocorticoid receptor target genes, its loss protecting mice from metabolic adverse effects of glucocorticoids. We aimed to analyze the role of E47 in patients with endogenous glucocorticoid excess [Cushing’s syndrome (CS)] and its association with disorders of lipid and glucose metabolism.MethodsThis is a prospective cohort study including 120 female patients with CS (ACTH-dependent = 79; ACTH-independent = 41) and 26 healthy female controls. Morning whole blood samples after an overnight fast were used to determine E47 mRNA expression levels in patients with overt CS before and 6–12 months after curative surgery. Expression levels were correlated with the clinical phenotype of the patients. Control subjects underwent ACTH stimulation tests and dexamethasone suppression tests to analyze short-term regulation of E47.ResultsE47 gene expression showed significant differences in patient cohorts with overt CS vs. patients in remission (p = 0.0474) and in direct intraindividual comparisons pre- vs. post-surgery (p = 0.0353). ACTH stimulation of controls resulted in a significant decrease of E47 mRNA expression 30 min after i.v. injection compared to baseline measurements. Administration of 1 mg of dexamethasone overnight in controls did not change E47 mRNA expression. E47 gene expression showed a positive correlation with total serum cholesterol (p = 0.0036), low-density lipoprotein cholesterol (p = 0.0157), and waist–arm ratio (p = 0.0138) in patients with CS in remission.ConclusionE47 is a GC-dependent gene that is upregulated in GC excess potentially aiming at reducing metabolic glucocorticoid side effects such as dyslipidemia.

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Whom Should We Screen for Cushing Syndrome? The Endocrine Society Practice Guideline Recommendations 2008 Revisited

Braun

Vogel

Zopp

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Background Cushing’s syndrome (CS) is a rare and serious disease with high mortality. Patients are often diagnosed late in the course of the disease. Whether defined patient populations should be screened outside the at risk populations defined in current guidelines remains a topic of discussion. Patients and methods As part of the prospective German Cushing’s registry, we studied 377 patients with suspected CS. The chief complaint for CS referral was documented. Using urinary free cortisol, late-night salivary cortisol, and the 1 mg dexamethasone suppression test as well as long-term clinical observation, CS was confirmed in 93 patients, and ruled out for the remaining 284. Results Patients were referred for 18 key symptoms, of which five were more common in patients with CS than in those where CS was ruled out: Osteoporosis (8% vs. 2%, p = 0.02), adrenal incidentaloma (17% vs. 8%, p = 0.01), metabolic syndrome (11% vs. 4%, p = 0.02), myopathy (10% vs. 2%, p <0.001) and presence of multiple symptoms (16% vs. 1%, p < 0.001). Obesity was more common in patients where CS was ruled out (30% vs. 4%, p <0.001), but recent weight gain was prominent in those with CS. 68 of 93 patients with CS (73%) had typical chief complaints, as did 106 of 284 of patients with rule-out CS status (37%) according to the Endocrine Society practice guideline 2008. Conclusions The 2008 Endocrine Society Practice guideline for screening and diagnosis of CS defined at-risk populations that should undergo testing. These recommendations are still valid in 2022.

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Signs, symptoms and biochemistry in recurrent Cushing disease: a prospective pilot study

Cited by 3 publications

References 19 publications

Long‐term morbidity and mortality in patients with Cushing's syndrome

Long‐term morbidity and mortality in patients with Cushing's syndrome

E47 as a novel glucocorticoid-dependent gene mediating lipid metabolism in patients with endogenous glucocorticoid excess

Whom Should We Screen for Cushing Syndrome? The Endocrine Society Practice Guideline Recommendations 2008 Revisited

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