Successful control of Cushing's disease in the elderly with long term metyrapone

Donckier, Julian; Burrin, J. M.; Ramsay, Ian; Joplin, G. F.

doi:10.1136/pgmj.62.730.727

Cited by 24 publications

(19 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Treatment with metyrapone in CD has been documented in case reports (525)(526)(527) and in five main studies including a total of 120 patients with CD (506,507,524,528,529). In these studies, the dosage of metyrapone ranged from 500 to 6000 mg/d (mean, 2127.5 mg/d; median, 1750 mg/d), with a follow-up ranging from 0.25 to 66 months (mean, 8.7 mo; median, 5.5 mo).…”

Section: Metyraponementioning

confidence: 96%

See 1 more Smart Citation

The Treatment of Cushing's Disease

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Section: Metyraponementioning

confidence: 96%

“…Moreover, a case report described successful control of disease in an elderly woman with CD after long-term treatment with metyrapone (525).…”

Section: Metyraponementioning

confidence: 99%

The Treatment of Cushing's Disease

et al. 2015

View full text Add to dashboard Cite

show abstract

“…There are few data on outcome in older patients with Cushing's syndrome. A lower post-operative recurrence rate has been suggested (10,26) and there is a report of metyrapone as successful treatment in the elderly (27).…”

Section: Discussionmentioning

confidence: 99%

Pituitary tumours in the elderly: a 20 year experience

Turner¹,

Adams²,

Wass³

1999

European Journal of Endocrinology

View full text Add to dashboard Cite

The proportion of the elderly in the population is increasing, and the appreciation and management of medical problems in this age group will therefore become more important. We therefore decided to determine the clinical features and types of pituitary tumour presenting in the elderly, and to examine the treatment and outcome in this group. We conducted a retrospective case-note review from a specialist endocrine and neurosurgical unit in a tertiary referral centre. Eighty-four patients aged 65 years and over on diagnosis of a pituitary tumour were referred to the unit between 1975 and 1996. There were 45 males and 39 females, and the mean age was 72.4 years (range 65-86). Over half of the pituitary lesions were non-functioning adenomas (NFAs) (60.7%). GH-secreting tumours were present in 11 (13.1%) and macroprolactinomas in 7 (8.1%). Four patients had microadenomas and 17 had miscellaneous pituitary-related lesions. Visual deterioration was the commonest mode of presentation in 33 (39.3%), but 54 (64.3%) had evidence of visual impairment on detailed examination. Despite the majority of patients (80.8%) having coexisting medical conditions, trans-sphenoidal surgery was performed in 60 (71.4%) and was well tolerated with a zero peri-and post-operative mortality rate, and post-operative complications in 11 (13.1%).Pituitary tumours in the elderly are most frequently NFAs that present with visual deterioration and hypopituitarism. The fact that 46.5% were pan-hypopituitary on diagnosis and that 64.3% of patients had visual impairment suggests a delay in diagnosis in this age group. Despite significant coexisting medical pathology in this large series of patients, surgery was safe and successful in the majority.

show abstract

“…11 A successful treatment with metyrapone has also been demonstrated in a 77-year-old woman with CD. 12 In this case, plasma ACTH and serum cortisol levels at 09.00 hours were 160 pg/mL and 14.0 mg/dL, respectively. Urinary free cortisol was 139 mg/day.…”

Section: Discussionmentioning

confidence: 95%

Successful remission using metyrapone in an elderly patient with Cushing disease accompanied by generalized edema

Ishikawa

Narita

Sato

et al. 2007

Geriatrics Gerontology Int

View full text Add to dashboard Cite

An 82-year-old woman was referred to our hospital because of hypoalbuminemia and generalized edema. Hypercortisolemia was subsequently found as the levels of serum cortisol and plasma adrenocorticotropic hormone (ACTH) sampled in a fasting morning were 140 pg/mL and 41.9 mg/dL, respectively. These hormones were not suppressed after taking low-dose dexamethasone the previous night and increased to a mild extent in response to administration of corticotrophin-releasing hormone, suggesting presence of pituitary adenoma producing ACTH (Cushing's disease). However, intrasella localization of pituitary adenoma could not be determined by magnetic resonance imaging. Soon after administration of metyrapone was started in an attempt to reduce her cortisol levels, the patient suffered from severe pneumonia. The pulmonary infection and peripheral edema were improved with decreases in cortisol levels by continuing metyrapone administration with antibiotics and finally she was discharged from the hospital on foot. Metyrapone is a useful therapeutic choice to achieve a remission of cortisol levels in the elderly patients with Cushing's disease in association with serious hypercortisolemia impending severe infection.

show abstract

Successful control of Cushing's disease in the elderly with long term metyrapone

Abstract: Summary:A 77-year old woman with pituitary-driven Cushing's disease is described. The condition was completely controlled on long-term treatment with metyrapone.

Cited by 24 publications

References 10 publications

The Treatment of Cushing's Disease

The Treatment of Cushing's Disease

Pituitary tumours in the elderly: a 20 year experience

Successful remission using metyrapone in an elderly patient with Cushing disease accompanied by generalized edema

Contact Info

Product

Resources

About