An individualized approach to the management of Cushing disease.

Autor: Fleseriu M; Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA. fleseriu@ohsu.edu.; Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA. fleseriu@ohsu.edu.; Pituitary Center, Oregon Health & Science University, Portland, OR, USA. fleseriu@ohsu.edu., Varlamov EV; Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA., Hinojosa-Amaya JM; Division of Endocrinology, Department of Medicine, Hospital Universitario 'Dr. José E. González', Autonomous University of Nuevo León, Monterrey, Mexico., Langlois F; Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada., Melmed S; Department of Medicine and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: Nature reviews. Endocrinology [Nat Rev Endocrinol] 2023 Oct; Vol. 19 (10), pp. 581-599. Date of Electronic Publication: 2023 Aug 03.
DOI: 10.1038/s41574-023-00868-7
Abstrakt: Cushing disease caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary corticotroph adenoma leads to hypercortisolaemia with high mortality due to metabolic, cardiovascular, immunological, neurocognitive, haematological and infectious conditions. The disorder is challenging to diagnose because of its common and heterogenous presenting features and the biochemical pitfalls of testing levels of hormones in the hypothalamic-pituitary-adrenal axis. Several late-night salivary cortisol and 24-h urinary free cortisol tests are usually required as well as serum levels of cortisol after a dexamethasone suppression test. MRI might only identify an adenoma in 60-75% of patients and many adenomas are small. Therefore, inferior petrosal sinus sampling remains the gold standard for confirmation of ACTH secretion from a pituitary source. Initial treatment is usually transsphenoidal adenoma resection, but preoperative medical therapy is increasingly being used in some countries and regions. Other management approaches are required if Cushing disease persists or recurs following surgery, including medications to modulate ACTH or block cortisol secretion or actions, pituitary radiation, and/or bilateral adrenalectomy. All patients require lifelong surveillance for persistent comorbidities, clinical and biochemical recurrence, and treatment-related adverse effects (including development of treatment-associated hypopituitarism). In this Review, we discuss challenges in the management of Cushing disease in adults and provide information to guide clinicians when planning an integrated and individualized approach for each patient.
(© 2023. Springer Nature Limited.)
Databáze: MEDLINE
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