Research on Cushing’s Disease Presented at ENDO 2013

Posted on June 24, 2013 by MaryO

endo-chart

Researchers at PHAR, in conjunction with experts from Novartis Pharmaceuticals Corporation, presented the results of several studies on Cushing’s disease at the Endocrine Society’s 95th Annual Meeting on June 19th, 2013.

Cushing’s disease, a pituitary disorder, is poorly studied because of its rarity. The PHAR research team reported on the incidence, treatment patterns, and annual economic burden associated with the disease–topics on which very little was previously known.

The three posters presented at ENDO can be viewed by clicking the links below:

Incidence of Cushing’s Disease in the United States

Real-World Treatment Patterns in Cushing’s Disease Patients in Two Large US Nationwide Databases: Application of a Novel, Graphical Methodology

Annual Economic Burden Associated with Cushing’s Disease in the United States

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Pasireotide for the treatment of Cushing’s disease

Posted on June 23, 2013 by MaryO

Posted online on June 17, 2013. (doi:10.1517/21678707.2013.807731)

Annamaria Colao †, Chiara Simeoli , Monica De Leo , Alessia Cozzolino , Rosario Pivonello

Department of Clinical Medicine and Surgery, Section of Endocrinology, Federico II University, Via Sergio Pansini 5,

80131 Naples

, Italy +39 0817462132; +39 0815465443; colao@unina.it

†Author for correspondence

Introduction: Pasireotide, a novel multireceptor targeted somatostatin analog is the first drug approved for treatment of adult patients with Cushing’s disease (CD) for whom pituitary surgery is not an option or has not been curative.

Areas covered: The review describes published data on efficacy and safety of pasireotide in CD patients. In particular, the review focuses on a Phase III study (CSOM230B2305) evaluating the outcomes of treatment with pasireotide at the doses of 600 and 900 µg twice daily for 12 months in 162 CD patients. This clinical trial reported a decrease in urinary free cortisol levels in the majority of patients, with a substantial reduction in nearly half and a normalization in > 25% of patients included in the study, accompanied by an improvement in clinical picture as well as a significant reduction in pituitary tumor size. Hyperglycemia appears as the most important side effect, requiring a careful monitoring and a prompt administration of glucose-lowering medications.

Expert opinion: Pasireotide seems to have a promising role as medical option for CD patients who experienced a failure or not candidate for neurosurgery; its employment will probably induce in the near future significant changes in the therapeutic approach to CD.

Read More: http://informahealthcare.com/doi/abs/10.1517/21678707.2013.807731

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Information for Cushing’s Patients on Korlym

Posted on June 22, 2013 by MaryO

Please note – On July 1st, Korlym will not be supplied by Curascript and Accredo any more.

Korlym will continue to be available, just through a different pharmacy called Centric Health Resources.  They are trying to reach all of you to introduce you to their program and enhanced services as well as set up your next shipment.

If you have not yet spoken with them, please call them at 866-758-7138.

For reference, their website is: http://www.centrichealthresources.com/

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A Subtle Case of Cushing’s

Posted on June 11, 2013 by MaryO
English: "Dr. Harvey Cushing," oil o...

English: “Dr. Harvey Cushing,” oil on canvas, by the American artist Edmund Tarbell. Courtesy of the Dittrick Medical History Center. (Photo credit: Wikipedia)

Synopsis: 36 year old male who presented with weight gain, proximal muscle weakness, and excessive sweating. Among multiple 24-hour urine free cortisol and midnight salivary tests, a minority were minimally elevated.

The diagnosis of Cushing’s disease was questioned over an eight month evaluation period.

The challenges of diagnosing Cushing’s disease are discussed.

Clinical History

Pre-Operative Imaging

Operative Findings

Surgical Pathology

Post-Operative Course

Discussion, Part 1

Discussion, Part 2


References

Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008 May;93(5):1526-40.

Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alì A, Giovagnetti M, Opocher G, Angeli A. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000 Feb;85(2):637-44.

Catargi B, Rigalleau V, Poussin A, Ronci-Chaix N, Bex V, Vergnot V, Gin H, Roger P, Tabarin A. Occult Cushing’s syndrome in type-2 diabetes. J Clin Endocrinol Metab. 2003 Dec;88(12):5808- 13.

Reimondo G, Pia A, Allasino B, Tassone F, Bovio S, Borretta G, Angeli A, Terzolo M. Screening of Cushing’s syndrome in adult patients with newly diagnosed diabetes mellitus. Clin Endocrinol (Oxf). 2007 Aug;67(2):225-9.

Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res. 2004 Mar;27(3):193-202.

Chiodini I, Mascia ML, Muscarella S, Battista C, Minisola S, Arosio M, Santini SA, Guglielmi G, Carnevale V, Scillitani A. Subclinical hypercortisolism among outpatients referred for osteoporosis. Ann Intern Med. 2007 Oct 16;147(8):541-8.

Cushing H, Bull Johns Hopkins Hospital, 1932; 50:137-195

Ross EJ, Linch DC. Cushing’s syndrome–killing disease: discriminatory value of signs and symptoms aiding early diagnosis. Lancet. 1982 Sep 18;2(8299):646-9.

Plotz CM, Knowlton AI, Ragan C. The natural history of Cushing’s syndrome. Am J Med. 1952 Nov;13(5):597-614.

Lindholm J, Juul S, Jørgensen JO, Astrup J, Bjerre P, Feldt-Rasmussen U, Hagen C, Jørgensen J, Kosteljanetz M, Kristensen L, Laurberg P, Schmidt K, Weeke J. Incidence and late prognosis of cushing’s syndrome: a population-based study. J Clin Endocrinol Metab. 2001 Jan;86(1):117-23.

Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006 May 13;367(9522):1605-17.

Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008 May;93(5):1526-40. Epub 2008 Mar 11.

Liu H, Bravata DM, Cabaccan J, Raff H, Ryzen E. Elevated late- night salivary cortisol levels in elderly male type 2 diabetic veterans. Clin Endocrinol (Oxf). 2005 Dec;63(6):642- 9.

Qureshi AC, Bahri A, Breen LA, Barnes SC, Powrie JK, Thomas SM, Carroll PV. The influence of the route of oestrogen administration on serum levels of cortisol-binding globulin and total cortisol. Clin Endocrinol (Oxf). 2007 May;66(5):632-5.

Newell-Price J, Trainer P, Perry L, Wass J, Grossman A, Besser M. A single sleeping midnight cortisol has 100% sensitivity for the diagnosis of Cushing’s syndrome. Clin Endocrinol (Oxf). 1995 Nov;43(5):545-50.

Papanicolaou DA, Yanovski JA, Cutler GB Jr, Chrousos GP, Nieman LK. A single midnight serum cortisol measurement distinguishes Cushing’s syndrome from pseudo-Cushing states. J Clin Endocrinol Metab. 1998 Apr;83(4):1163-7.

Pecori Giraldi F, Ambrogio AG, De Martin M, Fatti LM, Scacchi M, Cavagnini F. Specificity of first-line tests for the diagnosis of Cushing’s syndrome: assessment in a large series. J Clin Endocrinol Metab. 2007 Nov;92(11):4123-9. Epub 2007 Aug 14.

From UCLA Pituitary Tumor Program

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Researchers May Have Found the Cause of Cushing’s Disease

Posted on June 3, 2013 by MaryO

A team of researchers may have zeroed in on the cause of Cushing’s disease, a condition that leads to diabetes, obesity and the risk of premature death.

Location of the pituitary gland in the human brain

Location of the pituitary gland in the human brain (Photo credit: Wikipedia)(TR4). By reducing the TR4 in lab mice, they were able to reverse tumor growth and excess ACTH production.

More women than men get the disease, which begins usually between 20 and 50 with mostly benign tumors in the pituitary gland. It’s known that that condition results in excess production of adrenocorticotrophic hormone (ACTH). But until now, scientists haven’t been sure what drives the production of ACTH.

Now, UCLA researchers and their colleagues have zeroed in on the culprit: excessive production of testicular orphan nuclear receptor (TR4). By reducing the TR4 in lab mice, they were able to reverse tumor growth and excess ACTH production.

The findings, published in the journal Proceedings of the National Academy of Sciences, could point the way to targeted treatment of Cushing’s.

From http://www.thirdage.com/medical-care/researchers-find-the-cause-of-cushing-s-disease

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