Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
| Autor: | Marcos Manavela, Ana C. Cohen, Karina Danilowicz, Reynaldo M. Gómez, María A. Rossi, Graciela E. Cross, Dolores Clifton Goldney, Oscar D. Bruno |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Endocrinology Diabetes and Metabolism Urinary system lcsh:Medicine 030209 endocrinology & metabolism bilateral adrenalectomy lcsh:Diseases of the endocrine glands. Clinical endocrinology Gastroenterology corticotrophinoma Nelson Syndrome 03 medical and health sciences Young Adult 0302 clinical medicine Risk Factors Internal medicine medicine Humans Young adult Pituitary ACTH Hypersecretion Cortisol level Retrospective Studies lcsh:RC648-665 Nelson’s syndrome business.industry lcsh:R Nelson's syndrome Retrospective cohort study Adrenalectomy Cushing's disease Middle Aged Cushing’s disease medicine.disease Treatment Outcome 030220 oncology & carcinogenesis Bilateral adrenalectomy Female Complication business |
| Zdroj: | Archives of Endocrinology and Metabolism v.63 n.5 2019 Arquivos de Endocrinologia e Metabolismo Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) instacron:SBEM Archives of Endocrinology and Metabolism Archives of Endocrinology and Metabolism, Issue: ahead, Published: 27 JUN 2019 |
| Popis: | Objective We analyzed the clinical, biochemical, and imaging findings of adrenalectomized patients with Cushing’s disease (CD) in order to compare the characteristics of those who developed Nelson’s syndrome (NS) versus those who did not develop this complication (NNS), aiming to identify possible predictive factors for its occurrence. Subjects and methods We performed a retrospective review of the clinical records of a group of patients with CD who underwent TBA between 1974 and 2011. Results Out of 179 patients with CD, 13 (7.3%) underwent TBA. NS occurred in 6 of them (46%) after a mean of 24 months from the total bilateral adrenalectomy (TBA). Age at diagnosis, duration of Cushing’s syndrome (CS) until TBA, and steroid replacement doses were similar in both groups. Initial urinary cortisol levels (24-hour urinary free cortisol [UFC]) were significantly higher in the NS group than in the NNS group (p = 0.009). Four patients in the NS group and three of those in the NNS group received radiotherapy before TBA (p = 0.26). Three patients in the NS group presented residual tumors before TBA, compared with none in the NNS group (p = 0.04). At 1 year after TBA, the median ACTH level was 476 ng/L (240-1500 ng/L) in the NS group and 81 ng/L (48-330 ng/L) in the NNS group (p = 0.0007). Conclusion In conclusion, a residual tumor before TBA, higher 24-hour UFC at diagnosis, and increasing ACTH levels within 1 year after TBA emerged as predictive factors of development of NS. |
| Databáze: | OpenAIRE |
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