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https://www.readbyqxmd.com/read/29783006/technique-of-whole-sellar-stereotactic-radiosurgery-for-cushing-s-disease-results-from-a-multicenter-international-cohort-study
#1
Matthew J Shepard, Gautam U Mehta, Zhiyuan Xu, Hideyuki Kano, Nathaniel Sisterson, Yan-Hua Su, Michal Krsek, Ahmed M Nabeel, Amr El-Shehaby, Khaled A Kareem, Nuria Martinez-Moreno, David Mathieu, Brendan J McShane, Kevin Blas, Douglas Kondziolka, Inga Grills, John Y Lee, Roberto Martinez-Alvarez, Wael A Reda, Roman Liscak, Cheng-Chia Lee, L Dade Lunsford, Mary Lee Vance, Jason P Sheehan
BACKGROUND: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing's disease (CD) who have failed surgical/medical management. As many patients with recurrent/persistent CD lack an identifiable adenoma on neuro-imaging, whole-sellar SRS has been increasingly employed. We therefore sought to define the outcomes of patients undergoing whole-sellar SRS. METHODS: An international, multicenter, retrospective cohort-design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD...
May 18, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29781519/assessment-of-vertebral-microarchitecture-in-overt-and-mild-cushing-s-syndrome-using-trabecular-bone-score
#2
Helene Vinolas, Virginie Grouthier, Nadia Mehsen-Cetre, Amandine Boisson, Renaud Winzenrieth, Thierry Schaeverbeke, Charles Mesguich, Laurence Bordenave, Antoine Tabarin
OBJECTIVE: Osteoporotic fractures associated with Cushing's syndrome (CS) may occur despite normal bone mineral density (BMD). Few studies have described alterations in vertebral microarchitecture in glucocorticoid-treated patients and during CS. Trabecular bone score (TBS) estimates trabecular microarchitecture from dual-energy X-ray absorptiometry acquisitions. Our aim was to compare vertebral BMD and TBS in patients with overt CS and mild autonomous cortisol secretion (MACE), and following cure of overt CS...
May 21, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29779837/-hypertension-associated-with-paraparesis-of-the-lower-limbs-revealing-an-adrenal-adenoma
#3
E Tabti, A Benmekki, M H Bestaoui, M Messad, M A Ghembaza, A Lounici
Cushing's syndrome is a rare cause of high blood pressure. The originally adrenal cause is found in 15% of cases. We describe the case of a patient with hypertension associated with paraparesis of the lower limbs revealing a Cushing syndrome due to a left adrenal adenoma. A 23-year-old man consults for a paraparesis of the lower limbs. The highlighting of an arterial high blood pressure led to the realization of complementary examinations. Computed tomography of the abdomen shows a left adrenal mass. Chirurgical excision of the mass was performed and histological examination concluded with adrenal adenoma...
May 17, 2018: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29772894/trench-coats-cushing-and-gillies
#4
Kun Hwang
No abstract text is available yet for this article.
May 10, 2018: Archives of Craniofacial Surgery
https://www.readbyqxmd.com/read/29767319/endoscopic-vs-microscopic-transsphenoidal-surgery-for-cushing-s-disease-a-systematic-review-and-meta-analysis
#5
Leonie H A Broersen, Nienke R Biermasz, Wouter R van Furth, Friso de Vries, Marco J T Verstegen, Olaf M Dekkers, Alberto M Pereira
PURPOSE: Systematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing's disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size. METHODS: Nine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing's disease were eligible...
May 16, 2018: Pituitary
https://www.readbyqxmd.com/read/29766359/two-types-of-ectopic-cushing-syndrome-or-a-continuum-review
#6
REVIEW
Marta Araujo Castro, Mónica Marazuela Azpiroz
BACKGROUND: Two types of ectopic Cushing syndrome (ECS) are described: ECS associated with aggressive neoplasms, and ECS with indolent and occult tumors, however, there is a lack of studies that thoroughly review their characteristics. METHODS: A systematic review was carried out on PUBMED of all the papers about the ECS, in order to better define the types of this subcategory of Cushing's syndrome, highlighting the differential aspects between these subgroups. RESULTS: It was found that in 50% of cases the prototypic "aggressive" ECS is caused by small cell lung carcinomas (SCLC)...
May 15, 2018: Pituitary
https://www.readbyqxmd.com/read/29765354/pituitary-directed-therapies-for-cushing-s-disease
#7
REVIEW
Fabienne Langlois, Jennifer Chu, Maria Fleseriu
Cushing's disease (CD) is caused by a pituitary corticotroph neuroendocrine tumor inducing uncontrolled hypercortisolism. Transsphenoidal surgery is the first-line treatment in most cases. Nonetheless, some patients will not achieve cure even in expert hands, others may not be surgical candidates and a significant percentage will experience recurrence. Many patients will thus require medical therapy to achieve disease control. Pharmacologic options to treat CD have increased in recent years, with an explosion in knowledge related to pathophysiology at the molecular level...
2018: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29762697/sarcopenia-is-a-novel-predictor-of-the-need-for-rescue-therapy-in-hospitalized-ulcerative-colitis-patients
#8
Kelly C Cushing, Hamed Kordbacheh, Michael S Gee, Avinash Kambadakone, Ashwin N Ananthakrishnan
Background: Acute severe ulcerative colitis (ASUC) affects one in four patients with UC. Clinical parameters perform modestly in predicting need for rescue therapy. Sarcopenia and visceral adiposity predict natural history in Crohn's disease, but the role of such metabolic factors on ASUC outcomes is unknown. Aim: To define the effect of sarcopenia and visceral adiposity on outcomes in ASUC. Methods: We studied patients hospitalized for ASUC who underwent an abdominal CT scan during the hospitalization...
May 12, 2018: Journal of Crohn's & Colitis
https://www.readbyqxmd.com/read/29760304/metyrapone-responsive-ectopic-acth-secreting-pheochromocytoma-with-a-vicious-cycle-via-a-glucocorticoid-driven-positive-feedback-mechanism
#9
Minako Inoue, Ken Okamura, Chie Kitaoka, Fumio Kinoshita, Ryo Namitome, Udai Nakamura, Masaki Shiota, Kenichi Goto, Toshio Ohtsubo, Kiyoshi Matsumura, Yoshinao Oda, Masatoshi Eto, Takanari Kitazono
In ectopic ACTH-secreting pheochromocytoma, combined ACTH-driven hypercortisolemia and hyper-catecholaminemia are serious conditions, which can be fatal if not diagnosed and managed appropriately, especially when glucocorticoid-driven positive feedback is suggested with a high ACTH/cortisol ratio. A 46-year-old man presented with headache, rapid weight loss, hyperhidrosis, severe hypertension and hyperglycemia without typical Cushingoid appearance. Endocrinological examinations demonstrated elevated plasma and urine catecholamines, serum cortisol and plasma ACTH...
May 15, 2018: Endocrine Journal
https://www.readbyqxmd.com/read/29757946/role-of-venous-sampling-in-the-diagnosis-of-endocrine-disorders
#10
REVIEW
Ryan W England, Eliza B Geer, Amy R Deipolyi
Venous sampling is the gold standard for localizing abnormal hormone secretion in several endocrine disorders. The most common indication for venous sampling is in the workup of primary aldosteronism, adrenocorticotropic hormone-dependent Cushing's syndrome, and hyperparathyroidism. In experienced hands, venous sampling is safe and accurate. This review discusses the role of venous sampling in the workup of endocrine disease, describing the underlying anatomy and pathophysiology, as an understanding of these concepts is essential for technical and clinical success...
May 14, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29754645/cushing-s-syndrome-2018-best-practices-and-looking-ahead
#11
EDITORIAL
Adriana G Ioachimescu
No abstract text is available yet for this article.
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754644/cushing-s-syndrome-in-pediatrics-an-update
#12
REVIEW
Maya B Lodish, Margaret F Keil, Constantine A Stratakis
Cushing syndrome (CS) is a multisystem disorder resulting from the prolonged exposure to excess glucocorticoids. In children, CS most commonly results from the exogenous administration of steroids and the typical presentation is height deceleration concomitant with weight gain. Endogenous and ectopic causes are rare. CS in children may be associated with distinct germline and somatic mutations. Clinical practice guidelines are available assist clinicians. Patients should be referred to multidisciplinary centers of excellence with experience in endocrinology and surgery...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754643/pregnancy-in-patients-with-cushing-s-syndrome
#13
REVIEW
Marcio Carlos Machado, Maria Candida Barisson Vilares Fragoso, Marcello Delano Bronstein
Progress in diagnosis and treatment of endocrine diseases has made pregnancy possible for women with endocrinopathies, including Cushing's syndrome (CS). The risk of maternal-fetal complications in patients who are not biochemically controlled, however, is substantial. Therefore, the surgical and/or medical control of hypercortisolism is mandatory prior to conceiving. A diagnosis of de novo CS during gestation is difficult due to changes in the hypothalamic-pituitary-adrenal axis during pregnancy, which may lead to some clinical features suggestive of CS along with abnormal laboratory tests...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754642/medical-therapy-for-cushing-s-syndrome-in-the-twenty-first-century
#14
REVIEW
Nicholas A Tritos, Beverly M K Biller
Medical therapy has a useful adjunctive role in many patients with Cushing's syndrome. Patients with pituitary corticotroph adenomas who have received radiation therapy to the sella require medical therapy until the effects of radiation therapy occur. In addition, patients with Cushing's syndrome who cannot undergo surgery promptly, including those who are acutely ill and cannot safely undergo tumor resection, may benefit from medical therapy as a bridge to surgery. Other possible candidates for medical therapy are those with unresectable tumors or those whose tumor location remains unknown despite adequate diagnostic evaluation...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754641/the-ectopic-adrenocorticotropic-hormone-syndrome-rarely-easy-always-challenging
#15
REVIEW
Aimee R Hayes, Ashley B Grossman
Despite modern imaging techniques, differentiating ectopic adrenocorticotropic hormone (ACTH) syndrome from pituitary-dependent Cushing's syndrome, Cushing's disease, is especially difficult when well-differentiated carcinoids are the source of ACTH secretion, particularly pulmonary carcinoid tumors. ACTH-secreting pulmonary carcinoids, like the corticotroph adenomas causing Cushing's disease, are often small and difficult to detect, and patients present with a gradual onset of the classical signs and symptoms of Cushing's syndrome, indistinguishable from the presentation of Cushing's disease...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754640/adrenocortical-carcinoma-with-hypercortisolism
#16
REVIEW
Soraya Puglisi, Paola Perotti, Anna Pia, Giuseppe Reimondo, Massimo Terzolo
Adrenocortical carcinoma (ACC) is a rare and aggressive tumor. ACC may be associated with different syndromes of hormone excess, most frequently Cushing's syndrome with or without hypersecretion of androgens. Recent data suggest that cortisol excess is a negative prognostic factor in advanced and localized ACC. Surgery with radical intent, when feasible, is the most effective treatment for ACC with hypercortisolism. Mitotane is the medical treatment of choice, both postoperatively and in inoperable or metastatic cases...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754639/adrenal-surgery-for-cushing-s-syndrome-an-update
#17
REVIEW
Guido Di Dalmazi, Martin Reincke
Recent advances in the molecular pathogenesis and the natural history of Cushing's syndrome have improved the understanding of the management of this disease. The long-term efficacy of several cortisol-lowering medical treatments is currently under evaluation. However, adrenalectomy is a safe option for the treatment of patients affected by Cushing's syndrome. Unilateral adrenalectomy is the gold standard for treatment of adrenocortical adenomas associated with hypercortisolism. Bilateral adrenalectomy has been widely used in the past as definitive treatment of bilateral macronodular hyperplasia and persistent or recurrent Cushing's disease...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754637/new-molecular-targets-for-treatment-of-cushing-s-disease
#18
REVIEW
Elizabeth Foulkes, John Newell-Price
Despite the best outcomes from trans-sphenoidal surgery, approximately one-third of patients with Cushing's disease will need medical therapy. Current treatments have drawbacks and there is a clear clinical need for new therapies. Recent understanding of molecular pathways leading to excess ACTH secretion has identified key components that may be targeted with the aim to provide novel effective treatment for this devastating disease. These include testicular orphan nuclear receptor 4, heat shock protein 90, and epidermal growth factor receptor...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754636/outcomes-of-pituitary-radiation-for-cushing-s-disease
#19
REVIEW
Natasha Ironside, Ching-Jen Chen, Cheng-Chia Lee, Daniel M Trifiletti, Mary Lee Vance, Jason P Sheehan
Achievement of biochemical remission with preservation of normal pituitary function is the goal of treatment for Cushing's disease. For patients with persistent or recurrent Cushing's disease after transsphenoidal resection, radiation therapy may be a safe and effective treatment. Stereotactic radiosurgery is favored over conventional fractionated external beam radiation. Hormonal recurrence rates range from 0% to 36% at 8 years after treatment. Tumor control rates are high. New pituitary hormone deficiency is the most common adverse effect after stereotactic radiosurgery and external beam radiation...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29754635/prognostic-factors-of-long-term-remission-after-surgical-treatment-of-cushing-s-disease
#20
REVIEW
Adriana G Ioachimescu
Transsphenoidal surgery is the main treatment of patients with adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. Although biochemical remission occurs in most patients undergoing operations at specialized centers, the recurrence risk is significant. Visualization of microadenomas on preoperative imaging and confirmation of ACTH-positive adenomas have been associated with higher remission rates. Low cortisol levels in the first 2 weeks postoperatively have been associated with durable remission; however, recurrence cannot be excluded by any cortisol threshold...
June 2018: Endocrinology and Metabolism Clinics of North America
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