Retroperitoneal Adrenal-Sparing Surgery for the Treatment of Cushing’s Syndrome Caused by Adrenocortical Adenoma: 8-Year Experience With 87 Patients

Posted on March 14, 2012 by MaryO

Hong-chao He, Jun Dai, Zhou-jun Shen, Yu Zhu, Fu-kang Sun, Yuan Shao, Rong-ming Zhang, Hao-fei Wang, Wen-bin Rui and Shan Zhong

 

Abstract

Background  

The objective of this study was to present our 8-year experience with partial adrenalectomy via the retroperitoneal approach for the treatment of Cushing’s adenoma.

Methods  

A total of 93 patients who underwent adrenal surgery for Cushing’s adenoma from March 2003 to December 2010 were enrolled in this study. Preoperative, intraoperative, and postoperative variables were reviewed from the database. Student’s t test was used to analyze the continuous data, and the χ2 test was used to analyze the categoric data. A value of p < 0.05 was considered statistically significant.

Results  

Adrenal-sparing surgery was performed in 87 cases (31 by open surgery, 56 by retroperitoneal laparoscopy). Six patients underwent open/laparoscopic total adrenalectomy because of recurrent disease or a large size. The cure rate in our series was 97.8%. Hypertension resolved in 34 of 64 patients (53.1%), diabetes in 7 of 27 patients (25.9%) and obesity in 28 of 48 patients (58.3%). One patient died during the postoperative period. The intraoperative complication rate for the open surgery group was significantly higher than that for the retroperitoneal laparoscopy group (9.1 vs. 1.7%).

Conclusions  

The retroperitoneal approach is reliable and safe for treating Cushing’s syndrome. The laparoscopic technique can decrease the prevalence of intraoperative complications. Retroperitoneal laparoscopic partial adrenalectomy can be performed with extremely low morbidity and achieves an excellent outcome, although death may occur during the postoperative period in high-risk patients. Postoperative management plays an important role in the surgical treatment of Cushing’s syndrome.

 

Jun Dai is listed as co-first author.

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From http://www.springerlink.com/content/034754537j7586k2/

 

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The Adrenal Vein Sampling International Study (AVIS) for Identifying the Major Subtypes of Primary Aldosteronism

Posted on March 13, 2012 by MaryO
  1. Gian Paolo Rossi, 
  2. Marlena Barisa, 
  3. Bruno Allolio, 
  4. Richard J. Auchus, 
  5. Laurence Amar,
  6. Debbie Cohen, 
  7. Christoph Degenhart, 
  8. Jaap Deinum, 
  9. Evelyn Fischer, 
  10. Richard Gordon,
  11. Ralph Kickuth, 
  12. Gregory Kline, 
  13. Andre Lacroix, 
  14. Steven Magill, 
  15. Diego Miotto,
  16. Mitsuhide Naruse, 
  17. Tetsuo Nishikawa, 
  18. Masao Omura, 
  19. Eduardo Pimenta,
  20. Pierre-François Plouin, 
  21. Marcus Quinkler, 
  22. Martin Reincke, 
  23. Ermanno Rossi,
  24. Lars Christian Rump, 
  25. Fumitoshi Satoh, 
  26. Leo Schultze Kool, 
  27. Teresa Maria Seccia,
  28. Michael Stowasser, 
  29. Akiyo Tanabe, 
  30. Scott Trerotola, 
  31. Oliver Vonend, 
  32. Jiri Widimsky Jr.,
  33. Kwan-Dun Wu, 
  34. Vin-Cent Wu and 
  35. Achille Cesare Pessina

–Author Affiliations


  1. University of Padova (G.P.R., M.B., T.M.S., A.C.P.), Department of Medicine (DIMED) Internal Medicine 4, Padova, 35128 Italy; University Hospital Würzburg (B.A.), Department of Internal Medicine I, Endocrine and Diabetes Unit, Würzburg, 97080 Germany; University of Texas (R.J.A.), Southwestern Medical Center at Dallas, Dallas, Texas 75390; Hôpital Européen Georges Pompidou (L.A., P.-F.P.), Hypertension Unit, Paris, 75908 France; Hospital of The University of Pennsylvania (D.C.), Department of Internal Medicine, Philadelphia, Pennsylvania 19104; University Hospital Innenstadt (C.D.), Department of Clinical Radiology, Munich, 80336 Germany; Radboud University Nijmegen (J.D.), Department of Internal Medicine, Nijmegen, 6225GA Netherlands; University Hospital Innenstadt (E.F., M.R.), Department of Endocrinology, Munich, Germany; University of Queensland School of Medicine (R.G., E.P., M.S.), Greenslopes Hospital, Endocrine Hypertension Research Centre, Brisbane, 4120 Australia; University Hospital Würzburg (R.K.), Institute of Radiology, Würzburg, Germany; University of Calgary (G.K.), Foothills Medical Centre, Calgary, T2N4J8 Canada; Centre hospitalier de l’Université de Montréal (A.L.), Department of Medicine, Montreal, H2W 1T8 Canada; Medical College of Wisconsin (S.M.), Endocrinology Clinic Community Memorial Medical Commons, Menomonee Falls, Wisconsin 53051; University of Padova (D.M.), Department of Medicine (DIMED) Radiology, Padova, Italy; National Hospital Organization Kyoto Medical Center (M.N.), Department of Endocrinology Clinical Research Institute, Kyoto, 612-8555 Japan; Yokohama Rosai Hospital (T.N., M.O.), Department of Endocrinology and Metabolism, Yokohama City, 222-0036 Japan; Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin, Berlin, 10117 Germany; Azienda Ospedaliera Santa Maria Nuova (E.R.), Department of Internal Medicine, Reggio Emilia, 42123 Italy; Department of Nephrology (L.C.R., O.V.), Heinrich-Heine-University Düsseldorf, Düsseldorf, 40225 Germany; Tohoku University Hospital (F.S.), Department of Nephrology, Endocrinology and Vascular Medicine, Sendai, 980-8574 Japan; Department of Radiology (L.S.K.), Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; Institute of Clinical Endocrinology (A.T.), Tokyo Women’s Medical University, Tokyo, 162-8666 Japan; Hospital of The University of Pennsylvania (S.T.), Department of Radiology, Philadelphia, Pennsylvania; Charles University in Prague (J.W.), General Faculty Hospital, Third Department of Medicine, Prague, 12808 Czech Republic; and National Taiwan University Hospital (K.-D.W., V.-C.W.), Department of Internal Medicine, Taipei, 10048 Taiwan
  1. Address all correspondence and requests for reprints to: Prof. Gian Paolo Rossi, M.D., FACC, FAHA, Department of Medicine, Internal Medicine 4, University Hospital via Giustiniani, 2, 35126 Padova, Italy. E-mail: gianpaolo.rossi@unipd.it.

 

Abstract

Context: In patients who seek surgical cure of primary aldosteronism (PA), The Endocrine Society Guidelines recommend the use of adrenal vein sampling (AVS), which is invasive, technically challenging, difficult to interpret, and commonly held to be risky.

Objective: The aim of this study was to determine the complication rate of AVS and the ways in which it is performed and interpreted at major referral centers.

Design and Settings: The Adrenal Vein Sampling International Study is an observational, retrospective, multicenter study conducted at major referral centers for endocrine hypertension worldwide.

Participants: Eligible centers were identified from those that had published on PA and/or AVS in the last decade.

Main Outcome Measure: The protocols, interpretation, and costs of AVS were measured, as well as the rate of adrenal vein rupture and the rate of use of AVS.

Results: Twenty of 24 eligible centers from Asia, Australia, North America, and Europe participated and provided information on 2604 AVS studies over a 6-yr period. The percentage of PA patients systematically submitted to AVS was 77% (median; 19–100%, range). Thirteen of the 20 centers used sequential catheterization, and seven used bilaterally simultaneous catheterization; cosyntropin stimulation was used in 11 centers. The overall rate of adrenal vein rupture was 0.61%. It correlated directly with the number of AVS performed at a particular center (P = 0.002) and inversely with the number of AVS performed by each radiologist (P = 0.007).

Conclusions: Despite carrying a minimal risk of adrenal vein rupture and at variance with the guidelines, AVS is not used systematically at major referral centers worldwide. These findings represent an argument for defining guidelines for this clinically important but technically demanding procedure.

  • Received October 14, 2011.
  • Accepted January 31, 2012.
  • Copyright © 2012 by The Endocrine Society

From http://jcem.endojournals.org/content/early/2012/03/01/jc.2011-2830.abstract?rss=1

 

 

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Experimental Drug Shows Promise Against Cushing’s Disease

Posted on March 8, 2012 by MaryO

An experimental drug called pasireotide reduced levels of the “stress hormone” cortisol and improved symptoms in patients with Cushing’s disease, a new study found.

Cushing’s disease is a rare (three to five cases per million people) hormonal disorder that causes a wide range of health problems and, if untreated, significantly increases a patient’s risk of dying at a much younger age than normal, researchers said in a news release.

Weight gain, high blood pressure, mood swings, irregular or absent menstrual periods, insulin resistance, glucose intolerance and type 2 diabetes are among the symptoms of Cushing’s disease. It is a form of Cushing’s syndrome, which is caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol.

This phase 3 study of 162 patients in 18 countries found that treatment with pasireotide reduced cortisol secretion by an average of 50 percent and returned some patient’s cortisol levels to normal.

A phase 3 study means that a drug is in the final stages of testing that drugs undergo before they can be approved for treatment of a specific disease.

The study, funded by Novartis Pharma, appears in the March 8 issue of the New England Journal of Medicine.

Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City, is not associated with the study but is familiar with its findings.

Mezitis said the study showed that the experimental treatment “improved metabolic abnormalities and emotional difficulties. Therefore, pasireotide injections become an alternative to surgical resection of the pituitary ACTH-secreting tumor, and may be shown to work with the FDA-approved mifepristone, which blocks the action of cortisol at receptors in the body.”

Elevated blood sugar (glucose) levels occurred in 73 percent of the patients who took the drug, a side effect that requires close attention, according to senior study author Dr. Beverly Biller, of Massachusetts General Hospital.

Cushing’s patients already have difficulty processing glucose, she noted.

“Those patients who already were diabetic had the greatest increases in blood sugar, and those who were prediabetic were more likely to become diabetic than those who began with normal blood sugar,” Biller said in the hospital news release. “So this is real and needs to be monitored carefully.”

Mezitis agreed that careful patient monitoring is important. “Blood-sugar elevations are dose-dependent with pasireotide and will need to be managed as indicated for diabetes,” he said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about Cushing’s syndrome.

From http://www.drugs.com/news/experimental-shows-promise-against-cushing-s-36857….

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New pituitary specific treatment for Cushing’s

Posted on March 8, 2012 by MaryO

An investigational somatostatin analogue has significantly reduced elevated cortisol levels in patients with Cushing’s disease, researchers report.

Of 103 patients, 61 had a ‘substantial reduction’ (≥50%) in urinary free cortisol level at month six, the randomised double blind phase 3 trial found.

The reduction in urinary free cortisol in response to pasireotide was also accompanied by reductions in serum cortisol and plasma coticotropin levels, as well as improvements in signs and symptoms of Cushing’s disease, the US researchers reported in this week’s NEJM.

Body weight, systolic and diastolic blood pressure, and LDL cholesterol levels were significantly reduced, and scores for health related quality of life improved.

Side effects included transient gastrointestinal discomfort and hyperglycaemia related events.

From http://www.endocrinologyupdate.com.au/getmedia/c33e0997-d2d9-4783-be87-d95930240f3d/EU08_03_12.aspx?ext=.pdf&nodeid=2653342&utm_source=SilverpopMailing&utm_medium=email&utm_campaign=Endocrinology+Newsletter+MREC+Non+SP+-+send+-%3E+8%2F03%2F2012+3%3A50%3A08+PM&utm_content&fb_source=message

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Sharmyn McGraw is presenting a Webinar

Posted on March 7, 2012 by MaryO

If you haven’t registered for this important webinar, please do so soon. Space is limited.

Reserve your webinar seat now at: https://www3.gotomeeting.com/register/287161014

Please join us as Sharmyn McGraw presents “Lessons Learned in the Past Decade.” 

Almost 12 years ago (after Sharmyn’s own pituitary surgery), she and her pituitary neurosurgeon, Dr. Daniel Kelly, founded a pituitary tumor patient support group. The group now mails out more than 800 invitations to attend their bi-monthly meetings. The sessions are videotaped and put on online to help educate other patients and their families all around the world.

Sharmyn’s in-depth understanding of pituitary disorders comes not only from her own battle against Cushing’s disease, but from personal relationships with hundreds of patient worldwide.

Highlights of Sharmyn’s Media Appearances: The Discovery Health Channel: “Mystery Diagnosis” airing all around the world for the past 8 years. The Montel Williams Show, Medstar News Specials, CNN, Woman’s Day Magazine, Woman & Home Magazine (London), MSNBC.com, Biology of Humans textbook (Pearson/Prentice Hall Publishing), presentations at the American Medical Association Media Conference (NYC) and the National Institute of Woman’s Health (NIH).

Presentation:

“Lesson’s Learned in the Past Decade.”

• The Face – Who are we?
• The Disease – How far have we come and how far do we still need to go?
• Who Do We Become? – The barriers that kept patients searching for years for an answer to an insidious illness.
• How Do We Do Better? – The importance of persistence.
• Raising Public Awareness

Title: Lessons Learned in the Past Decade

Date: Monday, March 12, 2012

Time: 6:30 PM – 7:30 PM PDT

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 7, Vista, XP or 2003 Server

Macintosh®-based attendees
Required: Mac OS® X 10.5 or newer

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