Posted on March 6, 2023 by MaryO
Abstract
Objective
To evaluate whether age-related differences exist in clinical characteristics, diagnostic approach and management strategies in patients with Cushing’s syndrome included in the European Registry on Cushing’s Syndrome (ERCUSYN).
Methods
We analyzed 1791 patients with CS, of whom 1234 (69%) had pituitary-dependent CS (PIT-CS), 450 (25%) adrenal-dependent CS (ADR-CS) and 107 (6%) had an ectopic source (ECT-CS). According to the WHO criteria, 1616 patients (90.2%) were classified as younger (<65 years) and 175 (9.8%) as older (>65 years).
Results
Older patients were more frequently males and had a lower BMI and waist circumference as compared with the younger. Older patients also had a lower prevalence of skin alterations, depression, hair loss, hirsutism and reduced libido, but a higher prevalence of muscle weakness, diabetes, hypertension, cardiovascular disease, venous thromboembolism and bone fractures than younger patients, regardless of sex (p<0.01 for all comparisons). Measurement of UFC supported the diagnosis of CS less frequently in older patients as compared with the younger (p<0.05). An extra-sellar macroadenoma (macrocorticotropinoma with extrasellar extension) was more common in older PIT-CS patients than in the younger (p<0.01). Older PIT-CS patients more frequently received cortisol-lowering medications and radiotherapy as a first-line treatment, whereas surgery was the preferred approach in the younger (p<0.01 for all comparisons). When transsphenoidal surgery was performed, the remission rate was lower in the elderly as compared with their younger counterpart (p<0.05).
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Filed under: adrenal, Cushing's, pituitary, symptoms | Tagged: adrenal, ectopic, elderly, ERCUSYN, European Registry on Cushing’s Syndrome, pituitary | Leave a comment »
Posted on February 14, 2018 by MaryO
European Journal of Endocrinology — | February 14, 2018
Valassi E, et al. – This study was performed to assess how frequently preoperative medical treatment (PMT) was given to Cushing’s syndrome (CS) patients across Europe and to investigate differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery. In addition, the physicians determined if PMT influenced the postoperative outcome in pituitary-dependent CS (PIT-CS). In contrast with adrenal-dependent CS (ADR-CS), CS from an ectopic source (ECT-CS) and PIT-CS exhibited greater likelihood of receiving PMT. Data reported more severe clinical features at the diagnosis and poorer quality of life in PIT-CS patients treated with PMT. The interpretation of immediate postoperative outcome could be confounded with PMT. They recommended follow-up to definitely evaluate surgical results.
Methods
- A total of 1,143 CS patients entered into the ERCUSYN database from 57 centres in 26 countries.
- During this study, 69% patients presented with PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS), and 1% were classified as having CS from other causes (OTH-CS).
Results
- In this study, 20% of patients took PMT.
- PMT was offered more frequently in ECT-CS and PIT-CS compared to ADR-CS (p < 0.001).
- Ketoconazole (62%), metyrapone (16%), and a combination of both (12%) were the most commonly used drugs.
- The median (interquartile range) duration of PMT was 109 (98) days.
- More severe clinical features at diagnosis and poorer quality of life were noted in PIT-CS patients treated with PMT compared to those undergoing primary surgery (SX) (p < 0.05).
- PIT-CS patients treated with PMT were more likely to have normal cortisol (p < 0.01) and a lower remission rate (p < 0.01) within 7 days of surgery.
- Between SX and PMT groups, no differences in morbidity or remission rates were observed within 6 months of surgery.
Filed under: adrenal, Clinical trials, Cushing's, pituitary, Treatments | Tagged: adrenal, clinical trial, cortisol, Cushing's Syndrome, ERCUSYN, ketoconazole, pituitary | Leave a comment »
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