Outcomes of Patients with Nelson's Syndrome after Primary Treatment: A Multicenter Study from 13 UK Pituitary Centers
| Autor: | Marie Freel, Rupa Ahluwalia, Niamh M. Martin, John Newell-Price, Francesca Swords, Khyatisha Seejore, Rowena Speak, James Macfarlane, Stephanie E Baldeweg, Athanasios Fountas, Robert D Murray, Ziad Hussein, Tejpal S Purewal, Zhuomin Chong, Andrew S Powlson, William Drake, Miles J Levy, Muhammad Ashraf, Niki Karavitaki, Aparna Pal, Claire E Higham, Eugenie S Lim, Narendra Reddy, Mark Gurnell, Jolyon Dales, Tala Balafshan |
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| Přispěvatelé: | Gurnell, Mark [0000-0001-5745-6832], Apollo - University of Cambridge Repository |
| Rok vydání: | 2019 |
| Předmět: |
Male
SURGERY Endocrinology Diabetes and Metabolism medicine.medical_treatment Cushing’s Clinical Biochemistry tumor progression bilateral adrenalectomy Biochemistry THERAPY Cohort Studies Endocrinology Child Middle Aged Prognosis TUMORS Neoadjuvant Therapy ACTH-Secreting Pituitary Adenoma Treatment Outcome Female Cushing's Life Sciences & Biomedicine Adenoma Adult medicine.medical_specialty STEREOTACTIC RADIOSURGERY Nelson's syndrome Adolescent Urology Context (language use) Nelson Syndrome Endocrinology & Metabolism Young Adult Internal medicine ADENOMAS medicine MANAGEMENT Biomarkers Tumor Humans Aged Retrospective Studies Science & Technology Nelson’s syndrome business.industry Adrenalectomy MORTALITY Biochemistry (medical) Pituitary tumors Retrospective cohort study 1103 Clinical Sciences medicine.disease United Kingdom Radiation therapy Tumor progression CUSHINGS-DISEASE EXPERIENCE 1114 Paediatrics and Reproductive Medicine business Follow-Up Studies |
| DOI: | 10.17863/cam.47056 |
| Popis: | Context Long-term outcomes of patients with Nelson’s syndrome (NS) have been poorly explored, especially in the modern era. Objective To elucidate tumor control rates, effectiveness of various treatments, and markers of prognostic relevance in patients with NS. Patients, design, and setting Retrospective cohort study of 68 patients from 13 UK pituitary centers with median imaging follow-up of 13 years (range 1–45) since NS diagnosis. Results Management of Cushing’s disease (CD) prior to NS diagnosis included surgery+adrenalectomy (n = 30; eight patients had 2 and one had 3 pituitary operations), surgery+radiotherapy+adrenalectomy (n = 17; two received >1 courses of irradiation, two had ≥2 pituitary surgeries), radiotherapy+adrenalectomy (n = 2), and adrenalectomy (n = 19). Primary management of NS mainly included surgery, radiotherapy, surgery+radiotherapy, and observation; 10-year tumor progression-free survival was 62% (surgery 80%, radiotherapy 52%, surgery+radiotherapy 81%, observation 51%). Sex, age at CD or NS diagnosis, size of adenoma (micro-/macroadenoma) at CD diagnosis, presence of pituitary tumor on imaging prior adrenalectomy, and mode of NS primary management were not predictors of tumor progression. Mode of management of CD before NS diagnosis was a significant factor predicting progression, with the group treated by surgery+radiotherapy+adrenalectomy for their CD showing the highest risk (hazard ratio 4.6; 95% confidence interval, 1.6–13.5). During follow-up, 3% of patients had malignant transformation with spinal metastases and 4% died of aggressively enlarging tumor. Conclusions At 10 years follow-up, 38% of the patients diagnosed with NS showed progression of their corticotroph tumor. Complexity of treatments for the CD prior to NS diagnosis, possibly reflecting corticotroph adenoma aggressiveness, predicts long-term tumor prognosis. |
| Databáze: | OpenAIRE |
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