Long-term Cognitive Effects of Glucocorticoid Excess in Cushing’s Syndrome

Posted on June 7, 2016 by MaryO

Psychoneuroendocrinology. 2016 Mar;65:26-33. doi: 10.1016/j.psyneuen.2015.11.020. Epub 2015 Nov 30.

Forget H1, Lacroix A2, Bourdeau I2, Cohen H3.

Abstract

CONTEXT AND OBJECTIVE:

We previously found that patients with Cushing’s syndrome (CS) scored lower than controls in several domains of cognitive function and that correction of hypercortisolism is not necessarily correlated with short-term improvement in intellectual performance. Here, we examined the long-term outcome in patients treated for CS by assessing the extent to which the detrimental effects of glucocorticoid (GC) excess on cognition can be reversed three years after corrective surgery.

DESIGN:

A battery of neuropsychological tests, including tests of attention, visuospatial processing, learning and memory, and executive functioning were administered pre-treatment and 12, 24 and 36 months post-treatment.

PATIENTS AND CONTROL SUBJECTS:

We included 18 patients with endogenous CS recruited before surgical treatment and 18 controls matched for age, sex and education.

RESULTS:

CS patients performed worse than controls on tests of attention, executive functioning and nonverbal aspects of memory. Moreover, at 36 months following eucortisolism, executive function performance and, to a lesser extent, attention tasks showed limited change compared to pre-treatment testing.

CONCLUSION:

Chronic hypercortisolism is accompanied by a deleterious impact on aspects of cognitive function. This negative effect on attention, executive performance and nonverbal memory seen in patients with CS suggests a differential effect of excess GCs upon different brain areas and networks. This influence persists years after the return to normal cortisol secretion levels.

Copyright © 2015 Elsevier Ltd. All rights reserved.

KEYWORDS:

Attention; Cognitive functions; Endogenous Cushing’s syndrome; Glucocorticoids; Hypercortisolism; Memory

PMID:
26708069
[PubMed – in process]

From http://www.ncbi.nlm.nih.gov/pubmed/26708069

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8th Annual Johns Hopkins Pituitary Patient Day

Posted on June 7, 2016 by MaryO

Johns Hopkins Pituitary Patient Day

Join us on Saturday, September 17, 2016

8th Annual Johns Hopkins Pituitary Patient Day
Saturday, September 17, 2016, 9:30 a.m.
Location:
Johns Hopkins Mt. Washington Conference Center
5801 Smith Avenue
Baltimore, MD 21209
map and directions

This is a free event, but seating is limited. Reserve your space now: Please R.S.V.P. by September 9, 2016 by email (preferred) to PituitaryDay@jhmi.edu  or by calling Alison Dimick at 410-955-3921.

Agenda

9:30 – 9:55 a.m.: Registration

9:55 – 10:00 a.m.: Welcome and Acknowledgements

10:00 – 10:25 a.m.: Different Kinds of Tumors in the Pituitary Area: Non-Functioning, Acromegaly, Cushing, etc. (Roberto Salvatori, M.D.)

10:25 – 10:50 a.m.: The Pituitary Gland, Cortisol and Stress (Gary Wand, M.D.)

10:50 – 11:10 a.m.: A Patient’s Story

11:10 – 11:30 a.m.: The Eye and the Pituitary Gland: Why It’s Important to SEE the Right Doctor (Pun Intended) (Dan Gold, D.O.)

11:30 – 11:50 a.m.: Surgery for Pituitary Tumors: (Not So Scary) Pictures from the Operating Room Treating Acromegaly, Cushing and Non-Functioning Tumors (Gary Gallia, M.D., Ph.D.)

11:50 a.m. – 12:10 p.m.: Coordinating the Care of Pituitary Patients: It Takes a Village (Pituitary Nurse)

12:10 – 12:30 p.m.: Radiation Therapy for Cushing, Acromegaly and Non-Functioning Tumors: A Good Option when Needed (Lawrence Kleinberg, M.D.)

12:30 – 1:25 p.m.: Lunch

1:30 – 3:00 p.m. Round Table Discussions:

  • Medical: Making Sense of So Many Medications
  • Surgical: Meet Surgeons and Patients Who Have Had Pituitary Surgery
  • Radiation: Share Your eX-peRience!

Filed under: Cushing's, Meetings and Conferences, pituitary, Rare Diseases, symptoms, Treatments | Tagged: , , , , , , , , , | Leave a comment »

Webinar: Endoscopic Endonasal Surgery for the Treatment of Cushing’s Disease

Posted on June 6, 2016 by MaryO

Mon, Jun 13, 2016 11:00 AM – 12:00 PM EDT

Show in My Time Zone
Presented by:
Dr. Maria Koutourousiou
Webinar DescriptionAn update on the diagnosis and treatment options of Cushing’s disease. Description of the endoscopic endonasal approach for the management of CD. Surgical videos demonstration and comparison with the microscopic transsphenoidal approach. Surgical outcomes and adjuvant treatment.

Presenter Bio

Dr. Mary Koutourousiou is an attending Neurosurgeon and Assistant Professor at the University of Louisville. She is the Director of the Pituitary and Skull Base Program. Dr. Koutourousiou received her M.D. from the Aristotle University of Thessaloniki, Greece and completed her neurosurgical residency at the General Hospital of Athens “G. Gennimatas”, in Greece. She underwent subspecialty fellowship training in Endoscopic Pituitary Surgery and Minimally Invasive Neurosurgery at the UMC St. Radboud, Nijmegen, in the Netherlands. She moved to the United States in 2010 and completed four years of research and a clinical fellowship in Endoscopic and Open Skull Base Surgery at UPMC Presbyterian in Pittsburgh, Pennsylvania.

Dr. Koutourousiou has published extensively in the field of endoscopic skull base surgery. Her studies have been presented in national and international neurosurgical meetings. Dr. Koutourousiou’s work in skull base surgery has been recognized by the European Skull Base Society and the World Federation of Skull Base Societies.

Register here: https://attendee.gotowebinar.com/register/4982773766837282305?utm_source=newsletter_199&utm_medium=email&utm_campaign=webinar-announcement-endoscopic-endonasal-surgery-for-the-treatment-of-cushing-s-disease

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Masked renal dysfunction in patients with adrenal Cushing’s syndrome manifested by adrenalectomy

Posted on May 31, 2016 by MaryO

INTRODUCTION AND OBJECTIVES

Many patients with primary aldosteronism (PA) exhibit a decline in renal function after adrenalectomy. Excessive aldosterone secretion causes glomerular hyperfiltration, and cancellation of this excessive secretion manifests the masked renal dysfunction. Considering the mineralocorticoid effect of cortisol as with aldosterone, excessive cortisol secretion may also mask the renal dysfunction of patients with adrenal Cushing’s syndrome (CS). However, postoperative changes in renal function in patients with CS have not been evaluated. We evaluated changes in renal function after adrenalectomy in patients with functional adrenal tumor.

METHODS

A total of 164 consecutive patients underwent adrenalectomy for unilateral functional adrenal tumor at our institution between January 2004 and October 2014. Of the 164 patients, we retrospectively analyzed 118 patients (PA/CS/subclinical Cushing’s syndrome [SCS]/pheochromocytoma [PCC]: n = 51/21/13/33, respectively) who were followed up for over 6 months and whose change in renal function was evaluable. Laboratory data, including baseline hormone levels before medical treatment, were collected from medical records. Estimated glomerular filtration rate (eGFR) values were obtained using the 3-variable Japanese equation. Renal dysfunction was defined as a 20% reduction in eGFR from baseline to within 3 times average during the 6 months post-operation. The change in eGFR before and after the operation was analyzed in each adrenal tumor.

RESULTS

The mean change in eGFR before and after the operation was -14% (range, -55%-18%) in patients with PA, -9% (-48%-23%) in patients with CS, -2% in patients with SCS, and -2% in patients with PCC. The eGFR decline in patients with PA and CS was significant (p < 0.0001 and p = 0.0171, respectively), while there was no significant change in patients with SCS and PCC. After the operation, 39% (20/51) and 24% (5/21) of patients with PA and CS manifested renal dysfunction, respectively, while none of the patients with SCS and PCC manifested renal dysfunction. Preoperative renal function was not correlated with manifested renal dysfunction. Multivariate analysis identified older age and higher levels of plasma aldosterone concentration as independent predictors of renal dysfunction manifestation in patients with PA, while no clinical predictor was identified in patients with CS.

CONCLUSIONS

This is the first report that has shown a decline in eGFR after adrenalectomy in patients with CS. Possible masked renal damage should be considered in patients with CS as well as PA.

Download PDF of the entire article.

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Role of radiosurgery in management of pituitary adenoma-The BNI experience

Posted on May 30, 2016 by MaryO

Screenshot 2016-05-27 13.12.55

 

S Meah, E Youssef, W White

Summary: Researchers conducted this study to determine the efficacy of stereotactic radiosurgery with CyberKnife for the treatment of recurrent pituitary adenoma. They concluded that stereotactic radiosurgery for recurrent/residual pituitary adenomas using CyberKnife appears to be relatively safe and effective when compared to conventional radiotherapy.

Methods:

  • Included in this retrospective study were patients who underwent cyberKnife radiosurgery for recurrent or residual pituitary adenoma at Barrow Neurological Institute (n=48).
  • Patients were followed for an average of 44 months.
  • Thirty-three patients had non-functioning adenomas, 10 had acromegaly, and 5 had Cushing’s disease.
  • Researchers analyzed the change in tumor size, hormonal function, and complication of therapy for each patient.

Results:

  • Tumor resection operation was performed through either the transsphenoidal or transcranial approach before CyberkKnife treatment.
  • All patients had either recurrence or residual mass in the cavernous sinus before CyberKnife treatment.
  • The total irradiation dose ranged from 2100-4000 cGy in an average of 3-5 fractions.
  • Slightly more than half of the patients (n=26, 54.2%) had smaller tumors at follow-up, while 22 (45.8%) had stable tumors.
  • Visual acuity remained unchanged post-treatment.
  • One patient developed radiation-induced temporal lobe necrosis.
  • Four patients (8.3%) required hormonal replacement due to panhypopituitarism.
  • Of the 15 patients with functioning adenoma, hormonal function improved in 12.
  • Treatment failed in 1 patient with acromegaly, 2 patients with Cushing’s disease, and 1 patient with non-functioning adenoma.

From http://www.mdlinx.com/endocrinology/conference-abstract.cfm/ZZFEBE5A85394340E188330278A399E6CF/57978/?utm_source=confcoveragenl&utm_medium=newsletter&utm_content=abstract-list&utm_campaign=abstract-AACE2016&nonus=0

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