Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN

ERCUSYN Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)399-409
Number of pages11
JournalEuropean Journal of Endocrinology
Volume178
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

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Cushing Syndrome
Therapeutics
Metyrapone
Pituitary ACTH Hypersecretion
Ketoconazole
Ambulatory Surgical Procedures
Hydrocortisone

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Preoperative medical treatment in Cushing's syndrome : Frequency of use and its impact on postoperative assessment: Data from ERCUSYN. / ERCUSYN Study Group.

In: European Journal of Endocrinology, Vol. 178, No. 4, 01.04.2018, p. 399-409.

Research output: Contribution to journalArticle

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title = "Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN",
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.",
author = "{ERCUSYN Study Group} and Elena Valassi and Holger Franz and Thierry Brue and Feelders, {Richard A.} and Romana Netea-Maier and Stylianos Tsagarakis and Webb, {Susan M.} and Maria Yaneva and Martin Reincke and Michael Droste and Irina Komerdus and Dominique Maiter and Darko Kastelan and Philippe Chanson and Marija Pfeifer and Strasburger, {Christian J.} and Mikl{\'o}s T{\'o}th and Olivier Chabre and Michal Krsek and Carmen Fajardo and Marek Bolanowski and Alicia Santos and Trainer, {Peter J.} and Wass, {John A.H.} and Antoine Tabarin and A. Ambrogio and G. Aranda and M. Arosio and M. Balomenaki and P. Beck-Peccoz and C. Berr-Kirmair and J. Bollerslev and D. Carvalho and F. Cavagnini and E. Christ and J. Denes and C. Dimopoulou and A. Dreval and T. Dusek and E. Erdinc and Evang, {J. A.} and J. Fazel and S. Fica and E. Ghigo and M. Goth and Y. Greenman and V. Greisa and I. Halperin and I. Lambrescu and {Pecori Giraldi}, F.",
year = "2018",
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doi = "10.1530/EJE-17-0997",
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TY - JOUR

T1 - Preoperative medical treatment in Cushing's syndrome

T2 - Frequency of use and its impact on postoperative assessment: Data from ERCUSYN

AU - ERCUSYN Study Group

AU - Valassi, Elena

AU - Franz, Holger

AU - Brue, Thierry

AU - Feelders, Richard A.

AU - Netea-Maier, Romana

AU - Tsagarakis, Stylianos

AU - Webb, Susan M.

AU - Yaneva, Maria

AU - Reincke, Martin

AU - Droste, Michael

AU - Komerdus, Irina

AU - Maiter, Dominique

AU - Kastelan, Darko

AU - Chanson, Philippe

AU - Pfeifer, Marija

AU - Strasburger, Christian J.

AU - Tóth, Miklós

AU - Chabre, Olivier

AU - Krsek, Michal

AU - Fajardo, Carmen

AU - Bolanowski, Marek

AU - Santos, Alicia

AU - Trainer, Peter J.

AU - Wass, John A.H.

AU - Tabarin, Antoine

AU - Ambrogio, A.

AU - Aranda, G.

AU - Arosio, M.

AU - Balomenaki, M.

AU - Beck-Peccoz, P.

AU - Berr-Kirmair, C.

AU - Bollerslev, J.

AU - Carvalho, D.

AU - Cavagnini, F.

AU - Christ, E.

AU - Denes, J.

AU - Dimopoulou, C.

AU - Dreval, A.

AU - Dusek, T.

AU - Erdinc, E.

AU - Evang, J. A.

AU - Fazel, J.

AU - Fica, S.

AU - Ghigo, E.

AU - Goth, M.

AU - Greenman, Y.

AU - Greisa, V.

AU - Halperin, I.

AU - Lambrescu, I.

AU - Pecori Giraldi, F.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - 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.

AB - 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.

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U2 - 10.1530/EJE-17-0997

DO - 10.1530/EJE-17-0997

M3 - Article

C2 - 29440375

AN - SCOPUS:85044620904

VL - 178

SP - 399

EP - 409

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 0804-4643

IS - 4

ER -