Cushing’s syndrome – Disease monitoring: Recurrence, surveillance with biomarkers or imaging studies

Publication date: Available online 30 January 2020Source: Best Practice &Research Clinical Endocrinology &MetabolismAuthor(s): Oskar RagnarssonAbstractPituitary surgery is the first-line treatment for patients with Cushing’s disease. For patients who are not considered candidates for pituitary surgery, pituitary radiation and bilateral adrenalectomy are further treatment alternatives. Not all patients are cured with pituitary surgery, and a substantial number of patients develop recurrence, sometimes many years after an apparently successful treatment. The same applies to patients treated with radiotherapy. Far from all patients are cured, and in many cases the disease recurs. Bilateral adrenalectomy, although always curative, causes chronic adrenal insufficiency and the remaining pituitary tumour can continue to grow and cause symptoms due to pressure on adjacent tissues, a phenomenon called Nelson’s syndrome.In this paper the rate of recurrence of hypercortisolism, as well as the rate of development of Nelson’s syndrome, following treatment of patients with Cushing’s syndrome, will be reviewed. The aim of the paper is also to summarize clinical and biochemical factors that are associated with recurrence of hypercortisolism and how the patients should be monitored following treatment.
Source: Best Practice and Research Clinical Endocrinology and Metabolism - Category: Endocrinology Source Type: research

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Conclusion The basal cortisol level on the second postoperative day is a valuable tool to predict integrity of the HPA axis after pituitary tumor surgery. Our data suggest that the cortisol level of ≥300 nmol/L accurately predicts adrenal sufficiency and that in these patients glucocorticoid therapy can be withdrawn. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Experimental and Clinical Endocrinology and Diabetes - Category: Endocrinology Authors: Tags: Article Source Type: research
Authors: Okuma H, Hashimoto K, Ohashi T, Mihara M, Minami I, Izumiyama H, Sasaki S, Inoshita N, Nishioka H, Yamada S, Yoshimoto T Abstract A 29-year-old man was referred to our department due to adrenal insufficiency with the inappropriate secretion of TSH (SITSH). Magnetic resonance imaging revealed a pituitary tumor. A weak TSH response in the TRH test, elevated sex hormone binding globulin (SHBG) levels, and the absence of a family medical history of SITSH or TRβ gene mutations supported the diagnosis of TSH-secreting pituitary adenoma (TSHoma). However, complete TSH suppression and a blunted cholesterol re...
Source: Endocrine Journal - Category: Endocrinology Tags: Endocr J Source Type: research
We present a case of secondary adrenal insufficiency caused by a pituitary tumor. During the course of evaluation and treatment, the patient developed a psychotic episode. We will briefly review the condition of adrenal insufficiency and propose how hypocortisolemia can result in psychosis. Keywords: Psychosis, secondary adrenal insufficiency, hypocortisolemia, proinflammatory cytokines Innov Clin Neurosci. 2017;14(9–10):4–10 Incidentally found lesions of the pituitary gland, referred to as “pituitary incidentalomas,” are present in approximately 10 percent of individuals undergoing brain magnetic r...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Case Report Current Issue hypocortisolemia proinflammatory cytokines psychosis secondary adrenal insufficiency Source Type: research
ConclusionsCommon causes of periorbital edema include infections, inflammation, trauma, allergy, kidney or cardiac dysfunction, and endocrine disorders such as primary hypothyroidism. In the present case, the patient ’s acute central hypothyroidism was probably involved in the development of both periorbital edema and cardiac dysfunction. The present case highlights the need for physicians to consider periorbital edema as an unusual predominant manifestation of pituitary tumor apoplexy.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
CONCLUSIONS: The age, patient gender and the size of the tumor were not independent risk factors leading to postoperative pituitary tumor adrenal insufficiency. However, the occurrence rate of adrenal insufficiency of patients in high age group was higher than that of patients in low age group. Also, the occurrence rate of adrenal insufficiency of patients (whose one or several hormones dramatically decreased before the operation) was significantly higher than that of patients (whose hormone level did not decrease before the operation). So, the patients in high age group and whose one or several hormones dramatically decre...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
CONCLUSION: This study establishes a quality benchmark for readmission rates after transsphenoidal surgery for pituitary lesions and identifies delayed hyponatremia as the primary cause. Implementation of an outpatient care pathway for managing hyponatremia may improve readmission rates. ABBREVIATIONS: CMS, Centers for Medicare and Medicaid Services DI, diabetes insipidus SIADH, syndrome of inappropriate antidiuretic hormone
Source: Neurosurgery - Category: Neurosurgery Tags: Research-Human-Clinical Studies Source Type: research
Conclusion In the longest comparative study to date using a standard assessment modality, HPA axis recovery was more frequent in acromegaly compared to NFA patients, independent of tumor size, cavernous sinus invasion (CSI), and body mass index (BMI). HPA axis integrity must be carefully and periodically monitored in acromegaly patients during short- and long-term follow-up to prevent overtreatment with glucocorticoids.
Source: Pituitary - Category: Endocrinology Source Type: research
Authors: Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P Abstract Pituitary apoplexy (PA), a rare clinical syndrome secondary to abrupt hemorrhage or infarction, complicates 2-12% of pituitary adenomas, especially nonfunctioning tumors. Headache of sudden and severe onset is the main symptom, sometimes associated with visual disturbances or ocular palsy. Signs of meningeal irritation or altered consciousness may complicate the diagnosis. Precipitating factors (increase in intracranial pressure, arterial hypertension, major surgery, anticoagulant therapy or dynamic testing, etc.) may be identified. Corticotro...
Source: Endocrine Reviews - Category: Endocrinology Tags: Endocr Rev Source Type: research
THE TREATMENT OF CUSHING'S DISEASE. Endocr Rev. 2015 Jun 11;:er20131048 Authors: Pivonello R, Leo M, Cozzolino A, Colao A Abstract Cushing's disease (CD), or pituitary-dependent Cushing's syndrome (CS), is a severe endocrine disease caused by a corticotroph pituitary tumor, associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 75%, and relapse in around 15%, of patients during the ten-year period after surgery. Patients with persistent or recurrent CD require additional treatments, including pituitary ra...
Source: Endocrine Reviews - Category: Endocrinology Tags: Endocr Rev Source Type: research
Conclusion In the longest comparative study to date using a standard assessment modality, HPA axis recovery was more frequent in acromegaly compared to NFA patients, independent of tumor size, cavernous sinus invasion (CSI), and body mass index (BMI). HPA axis integrity must be carefully and periodically monitored in acromegaly patients during short- and long-term follow-up to prevent overtreatment with glucocorticoids.
Source: Pituitary - Category: Endocrinology Source Type: research
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