Details

Autor(en) / Beteiligte

• Valassi, Elena
• Franz, Holger
• Brue, Thierry
• Feelders, Richard A
• Netea-Maier, Romana
• Tsagarakis, Stylianos
• Webb, Susan M
• Yaneva, Maria
• Reincke, Martin
• Droste, Michael
• Komerdus, Irina
• Maiter, Dominique
• Kastelan, Darko
• Chanson, Philippe
• Pfeifer, Marija
• Strasburger, Christian J
• Tóth, Miklós
• Chabre, Olivier
• Krsek, Michal
• Fajardo, Carmen
• Bolanowski, Marek
• Santos, Alicia
• Trainer, Peter J
• Wass, John A H
• Tabarin, Antoine

Titel

Preoperative medical treatment in Cushing's syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN

Ist Teil von

• European journal of endocrinology, 2018-04, Vol.178 (4), p.399-409

Ort / Verlag

England

Erscheinungsjahr

2018

Quelle

MEDLINE

Beschreibungen/Notizen

• Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS). Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (  < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (  < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (  < 0.01) and a lower remission rate (  < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.