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Eur J Endocrinol. 2018 Apr;178(4):399-409. doi: 10.1530/EJE-17-0997. Epub 2018 Feb 12.

Preoperative medical treatment in Cushing's syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN.

Author information

1
IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain.
2
Lohmann & Birkner Health Care Consulting GmbHBerlin, Germany.
3
Aix-Marseille UniversitéCNRS, CRN2M UMR 7286, Marseille, France.
4
APHMHôpital Conception, Marseille, France.
5
Erasmus University Medical CentreRotterdam, The Netherlands.
6
Radboud University Medical CentreNijmegen, The Netherlands.
7
Athens Polyclinic General HospitalEvangelismos Hospital, Athens, Greece.
8
IIB-Sant Pau and Department of Endocrinology/MedicineHospital Sant Pau, UAB, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain swebb@santpau.cat.
9
Medical University of SofiaSofia, Bulgary.
10
Medizinische Klinik und Poliklinik IVCampus Innestadt, Klinikum der Universität München, München, Germany.
11
Praxis für Endokrinologie DrosteOldenburg, Germany.
12
Moscow Regional Research Clinical Institute n.a. VladimirskyMoscow, Russia.
13
UCL Cliniques Universitaires St LucBrussels, Belgium.
14
Department of EndocrinologyUniversity Hospital Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
15
Univ Paris-SudUniversité Paris-Saclay UMR-S1185, Paris, France.
16
Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service de Endocrinologie et des Maladies de la Reproduction, Paris, France.
17
Institut National de la Santé et de la Recherche Médicale U1185Paris, France.
18
Department of EndocrinologyUniversity Medical Centre Ljubljana, Ljubljana Slovenia.
19
Division of Clinical EndocrinologyDepartment of Medicine CCM, Charité-Universitätsmedizin, Berlin, Germany.
20
2nd Department of MedicineSemmelweis University, Budapest, Hungary.
21
Service d'Endocrinologie-Diabétologie-NutritionGrenoble Cedex, France.
22
2nd Department of Medicine3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
23
Department of EndocrinologyHospital Universitario de la Ribera, Alzira, Spain.
24
Department of EndocrinologyDiabetology and Isotope Therapy, Wroclaw Medical University, Wroclaw, Poland.
25
Department of EndocrinologyChristie Hospital, Manchester, UK.
26
Oxford University Hospital Foundation TrustOxford, UK.
27
Centre Hospitalier Universitaire de BordeauxBordeaux, France.

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.

PMID:
29440375
DOI:
10.1530/EJE-17-0997
[Indexed for MEDLINE]

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