Preoperative medical treatment in Cushing's syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Valassi, Elena; Franz, Holger; Brue, Thierry; Feelders, Richard A; Netea-Maier, Romana; Tsagarakis, Stylianos; Webb, Susan M; Yaneva, Maria; Reincke, Martin; Droste, Michael; Komerdus, Irina; Maiter, Dominique; Kastelan, Darko; Chanson, Philippe; Pfeifer, Marija; Strasburger, Christian J; Tóth, Miklós; Chabre, Olivier; Krsek, Michal; Fajardo, Carmen; Bolanowski, Marek; Santos, Alicia; Trainer, Peter J; Wass, John A H; Tabarin, Antoine
• Other Names: author non-byline.; Ambrogio A author non-byline.; Aranda G author non-byline.; Arosio M author non-byline.; Balomenaki M author non-byline.; Beck-Peccoz P author non-byline.; Berr-Kirmair C author non-byline.; Bollerslev J author non-byline.; Carvalho D author non-byline.; Cavagnini F author non-byline.; Christ E author non-byline.; Demtröder F author non-byline.; Denes J author non-byline.; Dimopoulou C author non-byline.; Dreval A author non-byline.; Dusek T author non-byline.; Erdinc E author non-byline.; Evang J A author non-byline.; Fazel J author non-byline.; Fica S author non-byline.; Ghigo E author non-byline.; Goth M author non-byline.; Greenman Y author non-byline.; Greisa V author non-byline.; Halperin I author non-byline.; Hanzu FA author non-byline.; Hermus A author non-byline.; Johannsson G author non-byline.; Kamenicky P author non-byline.; Kasperlik-Zaluska A author non-byline.; Kirchner J author non-byline.; Kraljevic I author non-byline.; Kruszynska A author non-byline.; Lambrescu I author non-byline.; Lang S author non-byline.; Luger A author non-byline.; Marpole N author non-byline.; Martin S author non-byline.; Martinie M author non-byline.; Moros O author non-byline.; Newell-Price J author non-byline.; Orbetzova M author non-byline.; Paiva I author non-byline.; Pecori Giraldi F author non-byline.; Pereira A M author non-byline.; Pickel J author non-byline.; Pirags V author non-byline.; Ragnarsson O author non-byline.; Reghina A D author non-byline.; Riesgo P author non-byline.; Roberts M author non-byline.; Roerink S author non-byline.; Roig O author non-byline.; Rowan C author non-byline.; Rudenko P author non-byline.; A Sahnoun M author non-byline.; Salvador J author non-byline.; Sigurjonsdottir HA author non-byline.; Skoric Polovina T author non-byline.; Smith R author non-byline.; Stachowska B author non-byline.; Stalla G author non-byline.; Tőke J author non-byline.; Ubina E author non-byline.; Vinay S author non-byline.; Wagenmakers M author non-byline.; Werner S author non-byline.; Young J author non-byline.; Zdunowski P author non-byline.; Zopf K author non-byline.; Zopp S author non-byline.; Zosin I author non-byline.;
• Is Part Of: European journal of endocrinology. Volume 178:Issue 4(2018)
• Page Start: 399
• Page End: 409
• Publication Date: 2018-04
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EJE-17-0997
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract : Background: Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. Objective: (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). Patients and methods: 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had 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: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS ( P < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) ( P < 0.05). Within 7 days of surgery, 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 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.