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 language | English |
|---|---|
| Pages (from-to) | 399-409 |
| Number of pages | 11 |
| Journal | European Journal of Endocrinology |
| Volume | 178 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 1 2018 |
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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 journal › Article
}
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.
UR - http://www.scopus.com/inward/record.url?scp=85044620904&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044620904&partnerID=8YFLogxK
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 -