Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2017
BIOCHEMICAL CONTROL DURING LONG-TERM FOLLOW-UP OF 230 ADULT PATIENTS WITH CUSHING DISEASE: A MULTICENTER RETROSPECTIVE STUDY.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Geer Eliza B, Shafiq Ismat, Gordon Murray B, Bonert Vivien, Ayala Alejandro, Swerdloff Ronald S, Katznelson Laurence, Lalazar Yelena, Manuylova Ekaterina, Pulaski-Liebert Karen J, Carmichael John D, Hannoush Zeina, Surampudi Vijaya, Broder Michael S, Cherepanov Dasha, Eagan Marianne, Lee Jackie, Said Qayyim, Neary Maureen P, Biller Beverly M K
Аннотация
OBJECTIVE: Cushing disease (CD) results from excessive exposure to glucocorticoids caused by an adrenocorticotropic hormone-secreting pituitary tumor. Inadequately treated CD is associated with significant morbidity and elevated mortality. Multicenter data on CD patients treated in routine clinical practice are needed to assess treatment outcomes in this rare disorder. The study purpose was to describe the burden of illness and treatment outcomes for CD patients.
METHODS: Eight pituitary centers in four U.S. regions participated in this multicenter retrospective chart review study. Subjects were CD patients diagnosed at ≥18 years of age within the past 20 years. Descriptive statistical analyses were conducted to examine presenting signs, symptoms, comorbidities, and treatment outcomes.
RESULTS: Of 230 patients, 79% were female (median age at diagnosis, 39 years; range, 18 to 78 years). Length of follow-up was 0 to 27.5 years (median, 1.9 years). Pituitary adenomas were 0 to 51 mm. The most common presenting comorbidities included hypertension (67.3%), polycystic ovary syndrome (43.5%), and hyperlipidemia (41.5%). Biochemical control was achieved with initial pituitary surgery in 41.4% patients (91 of 220), not achieved in 50.0% of patients (110 of 220), and undetermined in 8.6% of patients (19 of 220). At the end of follow-up, control had been achieved with a variety of treatment methods in 49.1% of patients (110 of 224), not achieved in 29.9% of patients (67 of 224), and undetermined in 21.0% of patients (47 of 224).
CONCLUSION: Despite multiple treatments, at the end of follow-up, biochemical control was still not achieved in up to 30% of patients. These multicenter data demonstrate that in routine clinical practice, initial and long-term control is not achieved in a substantial number of patients with CD.
ABBREVIATIONS: BLA = bilateral adrenalectomy CD = Cushing disease CS = Cushing syndrome eCRF = electronic case report form MRI = magnetic resonance imaging PCOS = polycystic ovary syndrome.
METHODS: Eight pituitary centers in four U.S. regions participated in this multicenter retrospective chart review study. Subjects were CD patients diagnosed at ≥18 years of age within the past 20 years. Descriptive statistical analyses were conducted to examine presenting signs, symptoms, comorbidities, and treatment outcomes.
RESULTS: Of 230 patients, 79% were female (median age at diagnosis, 39 years; range, 18 to 78 years). Length of follow-up was 0 to 27.5 years (median, 1.9 years). Pituitary adenomas were 0 to 51 mm. The most common presenting comorbidities included hypertension (67.3%), polycystic ovary syndrome (43.5%), and hyperlipidemia (41.5%). Biochemical control was achieved with initial pituitary surgery in 41.4% patients (91 of 220), not achieved in 50.0% of patients (110 of 220), and undetermined in 8.6% of patients (19 of 220). At the end of follow-up, control had been achieved with a variety of treatment methods in 49.1% of patients (110 of 224), not achieved in 29.9% of patients (67 of 224), and undetermined in 21.0% of patients (47 of 224).
CONCLUSION: Despite multiple treatments, at the end of follow-up, biochemical control was still not achieved in up to 30% of patients. These multicenter data demonstrate that in routine clinical practice, initial and long-term control is not achieved in a substantial number of patients with CD.
ABBREVIATIONS: BLA = bilateral adrenalectomy CD = Cushing disease CS = Cushing syndrome eCRF = electronic case report form MRI = magnetic resonance imaging PCOS = polycystic ovary syndrome.
Предметные рубрики MeSH
14-alpha Demethylase InhibitorsACTH-Secreting Pituitary AdenomaAdenomaAdolescentAdrenalectomyAdultAgedAntineoplastic AgentsCabergolineComorbidityEnzyme InhibitorsErgolinesFemaleFollow-Up StudiesHirsutismHormone AntagonistsHormonesHumansHyperlipidemiasHypertensionHypoglycemic AgentsKetoconazoleMaleMetyraponeMiddle AgedMifepristoneMuscle WeaknessMuscular AtrophyNeurosurgical ProceduresObesity, AbdominalPituitary ACTH HypersecretionPituitary IrradiationPolycystic Ovary SyndromeRetrospective StudiesRosiglitazoneSomatostatinStriae DistensaeThiazolidinedionesTreatment OutcomeTumor BurdenYoung Adult