Preoperative medical treatment in Cushing's syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN.
| Autor: | Valassi E; IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain., Franz H; Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany., Brue T; Aix-Marseille UniversitéCNRS, CRN2M UMR 7286, Marseille, France.; APHMHôpital Conception, Marseille, France., Feelders RA; Erasmus University Medical CentreRotterdam, The Netherlands., Netea-Maier R; Radboud University Medical CentreNijmegen, The Netherlands., Tsagarakis S; Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece., Webb SM; IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain swebb@santpau.cat., Yaneva M; Medical University of SofiaSofia, Bulgary., Reincke M; Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universität München, München, Germany., Droste M; Praxis für Endokrinologie DrosteOldenburg, Germany., Komerdus I; Moscow Regional Research Clinical Institute n.a. VladimirskyMoscow, Russia., Maiter D; UCL Cliniques Universitaires St LucBrussels, Belgium., Kastelan D; Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia., Chanson P; Univ Paris-SudUniversité Paris-Saclay UMR-S1185, Paris, France.; Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service de Endocrinologie et des Maladies de la Reproduction, Paris, France.; Institut National de la Santé et de la Recherche Médicale U1185Paris, France., Pfeifer M; Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana Slovenia., Strasburger CJ; Division of Clinical EndocrinologyDepartment of Medicine CCM, Charité-Universitätsmedizin, Berlin, Germany., Tóth M; 2nd Department of MedicineSemmelweis University, Budapest, Hungary., Chabre O; Service d'Endocrinologie-Diabétologie-NutritionGrenoble Cedex, France., Krsek M; 2nd Department of Medicine3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic., Fajardo C; Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain., Bolanowski M; Department of EndocrinologyDiabetology and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland., Santos A; IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain., Trainer PJ; Department of EndocrinologyChristie Hospital, Manchester, UK., Wass JAH; Oxford University Hospital Foundation TrustOxford, UK., Tabarin A; Centre Hospitalier Universitaire de BordeauxBordeaux, France. |
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| Jazyk: | angličtina |
| Zdroj: | European journal of endocrinology [Eur J Endocrinol] 2018 Apr; Vol. 178 (4), pp. 399-409. Date of Electronic Publication: 2018 Feb 12. |
| DOI: | 10.1530/EJE-17-0997 |
| Abstrakt: | Background: 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. Objective: (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). Patients and Methods: 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). Results: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS ( P < 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) ( P < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol ( P < 0.01) and a lower remission rate ( P < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results. (© 2018 European Society of Endocrinology.) |
| Databáze: | MEDLINE |
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