Therapeutic Objectives. Cushing s Disease Surgical Results. Cushing s Disease Surgical Results: Macroadenomas 10/24/2015
|
|
- Cornelia Crawford
- 5 years ago
- Views:
Transcription
1 Therapeutic Objectives Update on the Management of Lewis S. Blevins, Jr., M.D. Correct the syndrome by lowering daily cortisol secretion to normal Eradicate any tumor that might threaten the health of the patient Avoid permanent endocrine deficiency Avoid permanent dependency on medications Treatment of co-morbidities D.N. Orth NEJM 285: ,1971. Surgical Results Surgical Results: Macroadenomas FirstAuthor n Cure (%) Recurrence (%)Mean f/u (m) Invitti Bochicchio Blevins Sonino Mampalam Swearingen Nakane Hammer Author n Cure (%) Recurrence (%) f/u (m) Blevins Swearingen De Tomassi
2 Suggested Postoperative Approach Assume patients are rendered disease free May check serum cortisol postoperative day 2 Treat most patients with replacement doses of steroids Assess serum cortisol and ACTH levels in 4-6 weeks 36h post last dose of steroids Reasses at 3 month intervals When off steroids asses 24h UFC and diurnal variation Follow accordingly Causes of Surgical Failures Incomplete or failed tumor resection Invasive disease 8% of microadenomas 62% macroadenomas Negative MRI 26% failure vs. 13% Negative histopathology 47% failure vs. 17% Scheithauer et al. J Neurosurg 65: , Bochicchio et al. JCEM 80: ,1995. Causes of Surgical Failures Incorrect preoperative diagnosis Syndrome of ectopic ACTH hypersecretion Underreported, 2-5% Ectopic pituitary adenoma Cavernous sinus, suprasellar, stalk adenoma Corticotroph hyperplasia ~4% of pituitary-dependent cases of Cushing s Pseudo-Cushings Factitious Recurrent 2
3 for residual and recurrent Repeat surgery Radiotherapy Medical therapy Bilateral total adrenalectomy Combination therapy Repeat surgery Author n Cure (%) Recurrence (%) Blevins (micro) 0 (macro) Friedman Ram ? Swearingen 28 46? Locatelli 12 67? Observations on Repeat Surgery Patients may derive benefit even though not rendered disease free Restoration of normal cortisol levels Resolution of mass effects Alteration of tumor biology Morbidity and mortality are higher Advise repeat surgery when there is a reasonable chance that a subsequent procedure will accomplish clinically important benefits without significant risk. Radiotherapy Stereotactic Radiosurgery Identifiable lesion on MRI Documented intrasellar microadenoma if postoperative MRI is normal Opportunity to treat with low risk of injury to visual pathways Conventional Radiotherapy Widespread inoperable or invasive disease Lesions adjacent to visual pathways Latent risks 3
4 Conventional Radiotherapy Estrada et al: 83% in remission 6-60 m post-xrt Stereotactic Radiotherapy Sheehan et al: Gamma knife 63% of patients entered remission Mean time to remission 12 m (3-48m) 7% developed recurrent disease (19-38m) 16% developed additional pituitary deficits Devin et al: CPK 49% long-term control Mean time to normalization of UFC was 7.5 m 19% with recurrent hypercortisolism (17-64m) 40% developed pituitary insufficiency J Neurosurg 93: ,2000. Stereotact Funct Neurosurg 82: ,2004. Stereotactic Radiotherapy Indications for Medical Therapy Delay in surgical intervention of greater than 4-8 weeks During treatment planning and while awaiting the beneficial effects of XRT Vanderbilt Nashville, TN 4
5 Ketoconazole 38 patients, 5 stopped 1 st week mg (daily) for 23 months (mean). 45% responders. All controlled patients responded within 3 months. Fleseriu M. Neurosurg Clinics. 2012, in press. Castinetti F. Eur J Endocrinol 2008;158(1): Mifepristone Mifepristone and DM Glucocorticoid (GC) receptor antagonist at higher doses. binding affinity 3-4X> dex; 10+X > cortisol Anti-glucocorticoid effects at 4 mg/kg 1 mg of dexamethasone effectively competes 400 mg mifepristone in normal subjects Potent anti-progestin activity. FDA approved February 2012: Korlym TM for hyperglycemia associated with Cushing s Syndrome. Doses mg daily. 54 case reports SEISMIC study: 50 pts, 43 CD HbA1c (%) p<0.001 vs baseline p<0.001 vs baseline N=25 N=20 N=22 Baseline Week 16 Week 24/ET Nieman LK. Pituitary. 2002;5(2):77-82, Castinetti,, Eur J Endo 2009, 160 ( ) Fleseriu M et al. J Clin Endocrinol Metab. 2012; Jun;97(6): mean ± SD 5
6 % Change from baseline 2% 1% 0% -1% -2% -3% -4% -5% -6% Mifepristone and weight D7 D14 D28 W6 W8 W10 W12 W16 W20 W24 /ET Baseline 99.5 ± 4.4 kg n=46 Pasireoride Pasireotide is a 2 nd - generation somatostatin analog Binds to sst receptors inhibits ACTH secretion cortisol High binding affinity for sst 1, 2, 3, 5 Pituitary adenomas causing CD frequently over-express sst 5-7% -8% -9% mean ± SE Fleseriu M et al. J Clin Endocrinol Metab. 2012; Jun;97(6): * P<0.001 vs baseline 5.7 %± 1.5 vs Baseline Figure 1: Pharmacologic action of pasireotide. Source: Novartis Endocrinologic and Metabolic Drugs Advisory Committee Meeting, Nov. 7, 2012 Colao A, et al. NEJM Pasireotide Study Design: 12-month, phase 3, MC, DB, 2-arm, randomized trial in adults with persistent/recurrent CD or newly diagnosed CD who were not surgical candidates Treatment Regimens: pasireotide 600 µg BID (n = 82), 900 µg BID (n = 80) Results: Proportion with normalization of UFC levels at Month 6 w/out prior dose increase: 600 µg: 15% (95% CI 7, 22), 900 µg: 26% (95% CI 17, 36) Proportion with mean UFC ULN or 50% decrease from baseline at Month 6: 600 µg: 34%, 900 µg: 41% Pasireotide Mean changes in clinical signs/sx from baseline to Month 12: Systolic BP: 6.1 mmhg (95% CI: 9.8, 2.4; p = 0.03) Diastolic BP: 3.7 mmhg (95% CI: 6.2, 1.2; p = 0.03) Triglycerides: 2 mg/dl (95% CI: 27, 0; p-value NS) LDL cholesterol: 15 mg/dl (95% CI: 23, 8; p < 0.001) Weight: 6.7 kg (95% CI: 8.0, 5.4; p < 0.001) HR-QOL score, improved 11.1 points (95% CI: 6.8, 15.5; p-value NS) At Months 6 and 12, facial rubor, supraclavicular fat, and dorsal fat pads were diminished in patients with available photos Improvements in signs/sx not limited to those who achieved normal UFC Table 1: Mean change in UFC levels from baseline to Month Figure 2: Improvement in physical features from baseline to Month 12. Source: Novartis Endocrinologic and Metabolic Drugs Advisory Committee Meeting, Nov. 7,
7 Bilateral Total Adrenalectomy Adrenalectomy should only be employed as a last resort when all else has failed and the patient is in grave danger due to the consequences of hypercortisolism. The success and relatively low risk of complications of laparoscopic bilateral adrenalectomy, as demonstrated by centers such as The Mayo Clinic and Oregon Health Sciences University, require that we reconsider our attitudes towards adrenalectomy in patients with hypercortisolism. Treatment of A close doctor-patient relationship is essential. Decisions regarding treatment must depend on clinical, biochemical, and radiological findings and the level of expertise of the treating physicians. Patients should be permitted to make informed decisions regarding available treatment options. Life-long follow-up is essential. Serious consideration should be given to referral to a tertiary medical center for advice and management. 7
TREATMENT OF CUSHING S DISEASE
TREATMENT OF CUSHING S DISEASE Surgery, Radiation, Medication Peter J Snyder, MD Professor of Medicine Disclosures Novartis Research grant Pfizer Consultant Ipsen Research grant Cortendo Research grant
More informationADVANCES IN MANAGING CUSHING S DISEASE. Rosario Pivonello Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
ADVANCES IN MANAGING CUSHING S DISEASE Rosario Pivonello Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy Patients with persistent Cushing s disease have higher morbidity
More informationOctober 13, Surgical Nuances to Managing Cushing s Disease. Cortisol Regulation. Cushing s Syndrome Excess Cortisol. Sandeep Kunwar, M.D.
Surgical Nuances to Managing Cushing s Disease Cortisol Regulation Sandeep Kunwar, M.D. Surgical Director, California Center for Pituitary Disorders Associate Clinical Professor, University of California,
More informationUpdate on Cushing s disease (CD)
Update on Cushing s disease (CD) Beverly MK Biller, MD Professor of Medicine Harvard Medical School Neuroendocrine Clinical Center Massachusetts General Hospital Boston, MA Disclosure of potential relevant
More informationCortisol levels. Naturally produced by the adrenal Cortisol
1 + 2 Cortisol levels asleep awake Naturally produced by the adrenal Cortisol Man made tablets, injections, creams & inhalers Cortisone Hydrocortisone Prednisone Prednisolone Betamethasone Methylprednisolone
More informationClinical Commissioning Policy Proposition: Pasireotide: An injectable medical therapy for the treatment of Cushing's disease
Clinical Commissioning Policy Proposition: Pasireotide: An injectable medical therapy for the treatment of Cushing's disease Information Reader Box (IRB) to be inserted on inside front cover for documents
More informationSomatotroph Pituitary Adenomas (Acromegaly) The Diagnostic Pathway (11-2K-234)
Somatotroph Pituitary Adenomas (Acromegaly) The Diagnostic Pathway (11-2K-234) Common presenting symptoms/clinical assessment: Pituitary adenomas are benign neoplasms of the pituitary gland. In patients
More informationTitle: Prolactinomas, Cushing's disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas
Author's response to reviews Title: Prolactinomas, Cushing's disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas Authors: Beverly MK Biller (bbiller@partners.org)
More informationCase Report Monitoring Patient Improvement Parameters following Pasireotide Treatment in Cushing s Disease
Case Reports in Endocrinology Volume 2013, Article ID 735489, 5 pages http://dx.doi.org/10.1155/2013/735489 Case Report Monitoring Patient Improvement Parameters following Pasireotide Treatment in Cushing
More informationAcromegaly: Management of the Patient Who Has Failed Surgery
Acromegaly: Management of the Patient Who Has Failed Surgery Minnesota/Midwest Chapter of the American Association of Clinical Endocrinologists 8 th Annual Meeting October 14, 2017 Mark E. Molitch, M.D.
More informationDifferential Diagnosis of Cushing s Syndrome
Differential Diagnosis of Cushing s Syndrome Cushing s the Diagnostic Challenge Julia Kharlip, MD and Caitlin White, MD Endocrinology, Diabetes and Metabolism Perelman School of Medicine at the University
More informationCUSHING'S SYNDROME. Bharath University, Chrompet, Chennai, Tamil Nadu, India
TJPRC: International Journal of Nursing and Patient Safety & Care (TJPRC: IJNPSC) Vol. 1, Issue 1, Jun 2016, 57-62 TJPRC Pvt. Ltd. CUSHING'S SYNDROME R. RAMANI 1 & V. HEMAVATHY 2 1 Associate Professor,
More informationChallenging Pituitary Cases
Challenging Pituitary Cases Sue Samson, MD, PhD, FRCPC, FACE Associate Professor of Medicine and Neurosurgery Medical Director Pituitary Center Baylor College of Medicine, Houston TX Tom Blevins, MD, FNLA,
More informationMedical Therapy: Indications
Medical Therapy: Indications Severe complications of hypercortisolism Pre-treatment before pituitary surgery Post-treatment after unsuccessful surgery Bridging therapy before, during and after pituitary
More informationProfessor Ian Holdaway. Endocrinologist Auckland District Health Board
Professor Ian Holdaway Endocrinologist Auckland District Health Board A land of milk and giants hormonesecreting pituitary tumours I M Holdaway, Endocrinologist, Auckland Acromegaly Prolactinomas Cushing
More informationHigh and Low GH: an update of diagnosis and management of GH disorders
High and Low GH: an update of diagnosis and management of GH disorders Georgia Chapter-AACE 2017 Laurence Katznelson, MD Professor of Medicine and Neurosurgery Associate Dean of Graduate Medical Education
More informationChallenging Pituitary Cases
Challenging Pituitary Cases Sue Samson, MD, PhD, FRCPC, FACE Associate Professor of Medicine and Neurosurgery Medical Director Pituitary Center Baylor College of Medicine, Houston TX Tom Blevins, MD, FNLA,
More information2
1 2 General % Obesity 90 Hypertension 85 Skin Plethora 70 Hirsutism/hair loss 75 Striae 50 Acne 35 Bruising/thinning 35 Musculoskeletal Osteopenia/porosis 80 Weakness 65 Neuropsych % Lability,euphoria,insomnia,
More informationEndocrine Topic Review. Sethanant Sethakarun, MD
Endocrine Topic Review Sethanant Sethakarun, MD Definition Cushing's syndrome comprises a large group of signs and symptoms that reflect prolonged and in appropriately high exposure of tissue to glucocorticoids
More informationLong-term treatment of Cushing s disease with pasireotide: 5-year results from an open-label extension study of a Phase III trial
Endocrine (2017) 57:156 165 DOI 10.1007/s12020-017-1316-3 ORIGINAL ARTICLE Long-term treatment of Cushing s disease with pasireotide: 5-year results from an open-label extension study of a Phase III trial
More informationRepeat transsphenoidal surgery for Cushing's disease
J Neurosurg 71:520-527, 1989 Repeat transsphenoidal surgery for Cushing's disease ROBERT B. FRIEDMAN, M.D., EDWARD H. OLDFIELD~ M.D., LYNNETTE K. NIEMAN, M.D., GEORGE P. CHROUSOS, M.D., JOHN L. DOPPMAN,
More informationDavid Henley. Sir Charles Gairdner Hospital, Nedlands WA University of Western Australia. ESA Seminar Weekend, Melbourne Vic 27 th May 2017
David Henley Sir Charles Gairdner Hospital, Nedlands WA University of Western Australia ESA Seminar Weekend, Melbourne Vic 27 th May 2017 Disclosures Received honoraria from Ipsen, Novartis, Servier, Bristol-Myers
More informationAdvances in Pituitary. Anne Klibanski, M.D. Massachusetts General Hospital Harvard Medical School
Advances in Pituitary Anne Klibanski, M.D. Massachusetts General Hospital Harvard Medical School Pituitary tumor types Gonadotroph (15-40%) Clinically nonfunctioning Visual field loss Hypopituitarism Thyrotroph
More informationStudies on the diagnosis and treatment of canine Cushing s disease
Studies on the diagnosis and treatment of canine Cushing s disease Summary of the Doctoral Thesis Asaka Sato (Supervised by Professor Yasushi Hara) Graduate School of Veterinary Medicine and Life Science
More informationChallenging Pituitary Cases. Laurence Katznelson, MD Professor of Medicine and Neurosurgery Stanford University School of Medicine
Challenging Pituitary Cases Laurence Katznelson, MD Professor of Medicine and Neurosurgery Stanford University School of Medicine 1 34 yo male has incidental finding of large macroadenoma, with prolactin
More informationMANAGEMENT OF PATIENTS WITH CUSHING S DISEASE: A CANADIAN COST OF ILLNESS ANALYSIS
MANAGEMENT OF PATIENTS WITH CUSHING S DISEASE: A CANADIAN COST OF ILLNESS ANALYSIS S. Van Uum 1, M. Hurry 2, R. Petrella 1, C. Koch 2, G. Dranitsaris 3, A. Lacroix 4 1 Western University, Schulich School
More informationLong-term results of treatment in patients with ACTH-secreting pituitary macroadenomas
European Journal of Endocrinology (2003) 149 195 200 ISSN 0804-4643 CLINICAL STUDY Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas S Cannavò, B Almoto, C Dall Asta
More informationCUSHING SYNDROME Dr. Muhammad Sarfraz
Indep Rev Jul-Dec 2018;20(7-12) CUSHING SYNDROME Dr. Muhammad Sarfraz IR-655 Abstract: It is defined as clinical condition in which there are increased free circulating glucocorticoides casused by excessive
More informationMILD HYPERCORTISOLISM DUE TO ADRENAL ADENOMA: IS IT REALLY SUBCLINICAL?
MILD HYPERCORTISOLISM DUE TO ADRENAL ADENOMA: IS IT REALLY SUBCLINICAL? Alice C. Levine, MD Professor of Medicine Division of Endocrinology, Diabetes and Bone Diseases Georgia-AACE 2017 Annual Meeting
More informationC h a p t e r 3 8 Cushing s Syndrome : Current Concepts in Diagnosis and Management
C h a p t e r 3 8 Cushing s Syndrome : Current Concepts in Diagnosis and Management Padma S Menon Professor of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai A clinical syndrome resulting
More information(3) Pituitary tumours
Hypopituitarism Diabetes Insipidus Pituitary tumours (2) Dr T Kemp - Endocrinology and Metabolism Unit - Steve Biko Academic Hospital (3) Pituitary tumours Pituitary microadenoma - intrasellar adenoma
More informationstone) Policy covered: in patients d): Korlym is enrolled in diabetes or glucose Cushing s syndrome adult patients with treated with metabolic caused
Korlym (mifepris stone) Policy Number: 5.01.545 Origination: 06/2013 Last Review: 05/2014 Next Review: 05/2015 Policy BCBSKC will provide coverage for Korlym when it is determined to be medically necessary
More informationCase Report Metyrapone for Long-Term Medical Management of Cushing s Syndrome
Case Reports in Endocrinology Volume 2013, Article ID 782068, 4 pages http://dx.doi.org/10.1155/2013/782068 Case Report Metyrapone for Long-Term Medical Management of Cushing s Syndrome Andrea N. Traina,
More informationManaging Acromegaly: Biochemical Control with SIGNIFOR LAR (pasireotide)
Managing Acromegaly: Biochemical Control with SIGNIFOR LAR (pasireotide) INDICATION AND USAGE SIGNIFOR LAR (pasireotide) for injectable suspension is a somatostatin analog indicated for the treatment of
More informationI farmaci ad azione surrenalica: METIRAPONE ed OSILODROSTAT
I farmaci ad azione surrenalica: METIRAPONE ed OSILODROSTAT Maria Cristina De Martino Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II di Napoli, Italy 1 Treatment
More informationNeuroendocrine Disorders in Women
Neuroendocrine Disorders in Women Ursula B. Kaiser, M.D. Chief, Division of Endocrinology, Diabetes and Hypertension Brigham and Women s Hospital Professor of Medicine, Harvard Medical School Case Presentation
More informationThe endocrine system is made up of a complex group of glands that secrete hormones.
1 10. Endocrinology I MEDCHEM 535 Diagnostic Medicinal Chemistry Endocrinology The endocrine system is made up of a complex group of glands that secrete hormones. These hormones control reproduction, metabolism,
More informationLong term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas
Pituitary (2010) 13:223 229 DOI 10.1007/s11102-010-0221-z Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas Edward F. Chang Michael E. Sughrue
More informationULTIMATE BEAUTY OF BIOCHEMISTRY. Dr. Veena Bhaskar S Gowda Dept of Biochemistry 30 th Nov 2017
ULTIMATE BEAUTY OF BIOCHEMISTRY Dr. Veena Bhaskar S Gowda Dept of Biochemistry 30 th Nov 2017 SUSPECTED CASE OF CUSHING S SYNDROME Clinical features Moon face Obesity Hypertension Hunch back Abdominal
More informationCUSHING S SYNDROME. Australian Endocrine Society, May 26 th 2017
CUSHING S SYNDROME Ashley Grossman FMedSci Green-Templeton College, University of Oxford, Royal Free Hospital, London Barts and the London School of Medicine, London Australian Endocrine Society, May 26
More informationProcess / Evidence Class. Clinical Assessment / III
Table 2: Endocrine Author Cozzi et al (2009) 1 Study Design: Prospectively followed case series. Fourteen patients had pre-op hypocortisolism. Patient Population: Seventy-two adult patients who underwent
More informationLong-term results of gamma knife surgery for growth hormone producing pituitary adenoma: is the disease difficult to cure?
J Neurosurg (Suppl) 102:119 123, 2005 Long-term results of gamma knife surgery for growth hormone producing pituitary adenoma: is the disease difficult to cure? TATSUYA KOBAYASHI, M.D., PH.D., YOSHIMASA
More informationIndex. F Fatigue, 59 Food-dependent Cushing s syndrome, 286
A Abdominal red striae, 57, 58 Aberrant hormone receptors, AIMAH familial forms, 215 investigative protocols, 217 218 molecular mechanisms, 216, 217 paracrine mechanisms, 216 steroidogenesis, 212 213 in
More informationAVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2016 Mayo Foundation for Medical Education and Research.
More informationSharon maslovitz Lis Maternity Hospital
Sharon maslovitz Lis Maternity Hospital Case report Chief complaint 27 yo, with PMC @ 31+3w, BCBA twins Complaints of severe rt parietal and retrobulbar headaches Medical background Healthy until 24yo
More informationReview Article Diagnosis and Multimodality Management of Cushing s Disease: A Practical Review
International Endocrinology Volume 2013, Article ID 893781, 7 pages http://dx.doi.org/10.1155/2013/893781 Review Article Diagnosis and Multimodality Management of : A Practical Review Gabriel Zada Department
More informationmifepristone (Korlym )
mifepristone (Korlym ) Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ),
More informationPhysiology. The Hypothalamic Pituitary Adrenal Axis. Elena A Christofides, MD, FACE
Elena A Christofides, MD, FACE Endocrinology Associates, Inc Endocrinology Research Associates, Inc Physiology 2 The Hypothalamic Adrenal Axis A Complex Set of Feedback Influences* Hypothalamus releases
More informationRadiotherapy approaches to pituitary tumors
Disclosures No relevant disclosures Radiotherapy approaches to pituitary tumors Pituitary Disorders: Advances in Diagnosis and Management Steve Braunstein, MD, PhD UCSF Department of Radiation Oncology
More informationCUSHING S SYNDROME THE FACTS YOU NEED TO KNOW
CUSHING S SYNDROME THE FACTS YOU NEED TO KNOW Written by: Paul Margulies, MD, FACE, FACP, Medical Director, NADF. Clinical Associate Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell.
More informationMANAGEMENT OF HYPERGLYCEMIA IN A PATIENT WITH ACROMEGALY TREATED WITH PASIREOTIDE LAR: A CASE STUDY
Case Report MANAGEMENT OF HYPERGLYCEMIA IN A PATIENT WITH ACROMEGALY TREATED WITH PASIREOTIDE LAR: A CASE STUDY Murray B. Gordon, MD, FACE; Kellie L. Spiller, MS ABSTRACT Submitted for publication July
More informationManaging Acromegaly: Review of Two Cases
Managing Acromegaly: Review of Two Cases INDICATION AND USAGE SIGNIFOR LAR (pasireotide) for injectable suspension is a somatostatin analog indicated for the treatment of patients with acromegaly who have
More informationImaging pituitary gland tumors
November 2005 Imaging pituitary gland tumors Neel Varshney,, Harvard Medical School Year IV Two categories of presenting signs of a pituitary mass Functional tumors present with symptoms due to excess
More informationSubclinical Cushing s Syndrome
Subclinical Cushing s Syndrome AACE 26th Annual Scientific & Clinical Congress Associate Clinical Professor of Medicine and Clinical Chief University of Miami Miller Scholl of Medicine Miami, Florida aayala2@miami.edu
More informationTreatment of Cushing s Syndrome: An Endocrine Society Clinical Practice Guideline
SPECIAL FEATURE Clinical Practice Guideline Treatment of Cushing s Syndrome: An Endocrine Society Clinical Practice Guideline Lynnette K. Nieman (chair), Beverly M. K. Biller, James W. Findling, M. Hassan
More informationTreating a Growing Problem: A Closer Look at Acromegaly. Lisa Nachtigall, MD (Moderator) Nicholas Tritos, MD, DSc Brooke Swearingen, MD
Treating a Growing Problem: A Closer Look at Acromegaly Lisa Nachtigall, MD (Moderator) Nicholas Tritos, MD, DSc Brooke Swearingen, MD Goal Address key challenges faced by physicians who treat acromegaly
More informationCushing s disease: Results of treatment and factors affecting outcome
HORMONES 2011, 10(3):222-229 Research paper Cushing s disease: Results of treatment and factors affecting outcome Ariachery C. Ammini, 1 Saptarshi Bhattacharya, 1 Jaya Praksh Sahoo, 1 Jim Philip, 1 Nikhil
More informationSilent ACTHoma: A subclinical presentation of Cushing s disease in a 79 year old male
575 Silent ACTHoma: A subclinical presentation of Cushing s disease in a 79 year old male Meenal Malviya 1, Navneet Kumar 1*, Naseer Ahmad 2 1 MD; Department of Internal Medicine, Providence Hospital &
More informationAVS and IPSS: The Basics and the Pearls
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2018 Mayo Foundation for Medical Education and Research.
More informationCushing Syndrome in Pediatrics
Cushing Syndrome in Pediatrics Constantine A. Stratakis, MD, D (Med) Sci a,b, * KEYWORDS Cushing syndrome Pituitary tumors Cortisol Adrenal cortex Carney complex Adrenocortical hyperplasia Adrenal cancer
More informationRecent advances in the medical treatment of Cushing s disease Maria Fleseriu
Published: 03 March 2014 2014 Faculty of 1000 Ltd Recent advances in the medical treatment of Cushing s disease Maria Fleseriu Address: Northwest Pituitary Center, and Departments of Medicine and Neurological
More informationClinical Policy: Mifepristone (Korlym) Reference Number: CP.PHAR.101
Clinical Policy: (Korlym) Reference Number: CP.PHAR.101 Effective Date: 05/12 Last Review Date: 04/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory
More information14 Girl with Cushing s Disease: An Update. Kristen Dillard, MD Endorama October 17, 2013
14 Girl with Cushing s Disease: An Update Kristen Dillard, MD Endorama October 17, 2013 Initial Presentation Pt initially presented to pediatrician for school physical in fall 2012. Pt was found to be
More informationInt J Clin Exp Med 2016;9(6): /ISSN: /IJCEM
Int J Clin Exp Med 2016;9(6):11147-11156 www.ijcem.com /ISSN:1940-5901/IJCEM0021269 Original Article Clinical characteristics and surgical treatment of pituitary adrenocorticotropin-secreting macroadenomas:
More informationWilliam F. Young, Jr., MD, MSc Professor of Medicine, Mayo Clinic, Rochester, MN USA
The Year in Adrenal William F. Young, Jr., MD, MSc Professor of Medicine, Mayo Clinic, Rochester, MN USA Division of ENDOCRINOLOGY, DIABETES, METABOLISM & NUTRITION 2018 Mayo Foundation for Medical Education
More informationRadioterapia degli adenomi ipofisari
Radioterapia degli adenomi ipofisari G Minniti Radiation Oncology, Sant Andrea Hospital, University of Rome Sapienza, and IRCCS Neuromed, Pozzilli (IS) Roma 6-9 Novembre 14 ! Outline " Radiation techniques
More informationPrimary empty sella syndrome (ESS) is an anatomical. Effect of primary empty sella syndrome on pituitary surgery for Cushing s disease
J Neurosurg 121:518 526, 2014 AANS, 2014 Effect of primary empty sella syndrome on pituitary surgery for Cushing s disease Clinical article Gautam U. Mehta, M.D., 1,2 Kamran D. Bakhtian, M.S., 1 and Edward
More informationDiseases of the Adrenal gland
Diseases of the Adrenal gland Adrenal insufficiency Cushing disease vs syndrome Pheochromocytoma Hyperaldostronism What are the layers of the adrenal gland?? And what does each layer produce?? What are
More informationCushing it uphill: a Sisyphean case
Sunita MC De Sousa Ann I McCormack St Vincent s Hospital, Sydney ESA Clinical Weekend 2014 Cushing it uphill: a Sisyphean case None Declarations of interests 27 F, engaged to be married Weight gain, fatigue,
More informationAdrenal Tuberculosis in Cushing s Disease with Bilateral Macronodular Adrenocortical Hyperplasia
Endocrine Journal 2006, 53 (2), 219 223 Adrenal Tuberculosis in Cushing s Disease with Bilateral Macronodular Adrenocortical Hyperplasia HYUK-SANG KWON, SANG-IL KIM, SOON-JIB YOO, KUN-HO YOON, KWANG-WOO
More informationA 12-Month Phase 3 Study of Pasireotide in Cushing s Disease
T h e n e w e ngl a nd j o u r na l o f m e dic i n e original article A 12- Phase 3 Study of Pasireotide in Cushing s Disease Annamaria Colao, M.D., Ph.D., Stephan Petersenn, M.D., John Newell-Price,
More informationUndetectable postoperative cortisol does not always. predict long-term remission in Cushing s disease: a single centre audit*
Clinical Endocrinology (2002) 56, 25 31 Undetectable postoperative cortisol does not always Blackwell Science Ltd predict long-term remission in Cushing s disease: a single centre audit* L. B. Yap*, H.
More informationACTH-dependent Cushing s Syndrome Update AACE MI Chapter Annual Meeting September 22, Lynnette K. Nieman DEOB, NIDDK, NIH, DHHS
ACTH-dependent Cushing s Syndrome Update AACE MI Chapter Annual Meeting September 22, 2018 Lynnette K. Nieman DEOB, NIDDK, NIH, DHHS Objectives At the conclusion of this presentation, participants should
More informationEFFECTIVE MEDICAL THERAPY FOR CUSHING DISEASE CAN INCREASE THE SUSCEPTIBILITY TO RELATIVE HYPOCORTISOLISM
Case Report EFFECTIVE MEDICAL THERAPY FOR CUSHING DISEASE CAN INCREASE THE SUSCEPTIBILITY TO RELATIVE HYPOCORTISOLISM Kevin C.J. Yuen, MD, FRCP (UK), FACE; Jennifer U. Mercado, ARNP; Kelley Moloney, ARNP;
More informationPasireotide Long-Acting Repeatable (Signifor) for acromegaly first and second line
Pasireotide Long-Acting Repeatable (Signifor) for acromegaly first and second line December 2010 This technology summary is based on information available at the time of research and a limited literature
More informationGamma knife surgery in management of secretory pituitary adenoma Preliminary evaluation of role, efficacy and safety
International Journal of Clinical Medicine Research 2014; 1(2): 48-56 Published online June 10, 2014 (http://www.aascit.org/journal/ijcmr) Gamma knife surgery in management of secretory pituitary adenoma
More informationPITUITARY: JUST THE BASICS PART 2 THE PATIENT
PITUITARY: JUST THE BASICS PART 2 THE PATIENT DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and
More informationCushing s disease (CD), first described by Harvey
neurosurgical focus Neurosurg Focus 38 (2):E16, 2015 Update on the management of recurrent Cushing s disease Martin J. Rutkowski, MD, 1 Patrick M. Flanigan, BS, 1 and Manish K. Aghi, MD, PhD 1,2 1 Department
More informationPituitary Gland Disorders
Pituitary Gland Disorders 1 2 (GH-RH) (CRH) (TRH) (TRH) (GTRH) (GTRH) 3 Classification of pituitary disorders: 1. Hypersecretory diseases: a. Acromegaly and gigantism: Usually caused by (GH)-secreting
More informationClinical Study Clinical Characteristics of Endogenous Cushing s Syndrome at a Medical Center in Southern Taiwan
International Endocrinology Volume 2013, Article ID 685375, 7 pages http://dx.doi.org/10.1155/2013/685375 Clinical Study Clinical Characteristics of Endogenous Cushing s Syndrome at a Medical Center in
More informationCLINICALLY SILENT ACTH CROOKE S CELL ADENOMA PRESENTING AS UNILATERAL EAR PAIN
AACE Clinical Case Reports Rapid Electronic Articles in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited,
More informationOriginal Research Article
Medrech ISSN No. 2394-3971 Original Research Article TYPE 2 DIABETES WITH RECURRENT OSTEOPOROTIC FRACTURES, OR CUSHING S SYNDROME? Blertina Dyrmishi¹*; Taulant Olldashi²; Prof Asc Thanas Fureraj 3 ; Prof
More informationTABLES. Table 1: Imaging. Congress of Neurological Surgeons Author (Year) Description of Study Classification Process / Evidence Class
TABLES Table 1: Imaging Kremer et al (2002) 2 Study Design: Prospective followed case series. Patient Population: Fifty adult patients with NFPA Study Description: Patients underwent MRI before surgery,
More informationDownloaded from journal.bums.ac.ir at 20:00 IRST on Saturday October 6th " # $% & '( % ) *+!
(%& ')!"# 3 2 1 - -. " # $% & '( % ) *+! 0123 % & %" %5 )% /4 -+. /0123 + /4 $" /$% -+.+ /4 81 9:; %% 43 $4 -+ $% % /7. 6 /D 3 ':+" C; % % 90 ;?+@+ (> %") & (/0123) JK L+01 )% /4 %. 1 5 $% $ G. 81 6 E+F)+%
More informationPreliminary Experience with 3-Tesla MRI and Cushing s Disease
TECHNICAL NOTE Preliminary Experience with 3-Tesla MRI and Cushing s Disease LouisJ.Kim,M.D., 1 Gregory P. Lekovic, M.D., Ph.D., J.D., 1 William L.White, M.D., 1 and John Karis, M.D. 2 ABSTRACT Because
More informationSpontaneous remission of acromegaly and Cushing s disease following pituitary apoplexy: Two case reports
CASE REPORT Spontaneous remission of acromegaly and Cushing s disease following pituitary apoplexy: Two case reports S.H.P.P. Roerink 1 *, E.J. van Lindert 2, A.C. van de Ven 1 Departments of 1 Internal
More informationBroersen et al. Orphanet Journal of Rare Diseases (2019) 14:64 (Continued on next page)
Broersen et al. Orphanet Journal of Rare Diseases (2019) 14:64 https://doi.org/10.1186/s13023-019-1038-0 RESEARCH Open Access Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort
More informationCUSHING S SYNDROME AND CUSHING S DISEASE
PATIENT INFORMATION CUSHING S SYNDROME AND CUSHING S DISEASE YOUR QUESTIONS ANSWERED 2013 Update Contents What are Cushing s syndrome and Cushing s disease? What causes Cushing s syndrome and Cushing s
More informationLate-night salivary cortisol (LNSC) is a measure of nadir
ORIGINAL ARTICLE Accuracy of Late-Night Salivary Cortisol in Evaluating Postoperative Remission and in Cushing s Disease Fatemeh G. Amlashi, Brooke Swearingen, Alexander T. Faje, Lisa B. Nachtigall, Karen
More informationPituitary Tumors and Incidentalomas. Bijan Ahrari, MD, FACE, ECNU Palm Medical Group
Pituitary Tumors and Incidentalomas Bijan Ahrari, MD, FACE, ECNU Palm Medical Group Background Pituitary incidentaloma: a previously unsuspected pituitary lesion that is discovered on an imaging study
More informationJMSCR Vol 05 Issue 01 Page January 2017
MEN1, AIP, PRKAR1A and CDKN1B are familial pituitary syndromes found to be associated with four different genes. Pituitary gland is situated in hypophyseal fossa which is bounded supero-laterally by dural
More informationReview Thieme Stalla GK et al. The Adrenal Gland: Central. Exp Clin Endocrinol Diabetes 2018; 00: Cushing s Disease
Stalla GK et al. The Adrenal Gland: Central. Exp Clin Endocrinol Diabetes 2018; 00: 00 00 Cushing s Disease Authors Günter K. Stalla, Denis Ciato, Christina Dimopoulou Affiliation Department of Clinical
More informationPeri-op Pituitary / Diabetes Insipidus/ Apoplexy Dr. Stan Van Uum, MD, PhD, FRCPC
10 th Annual Canadian Endocrine Update 3 rd Canadian Endocrine Review Course Peri-op Pituitary / Diabetes Insipidus/ Apoplexy Dr. Stan Van Uum, MD, PhD, FRCPC 10 th Annual Canadian Endocrine Update Dr.
More informationCUSHING S SYNDROME. Chapter 8. Case: A 43-year-old man with delusions
Chapter 8 CUSHING S SYNDROME Case: A 43-year-old man with delusions A previously healthy 43-year-old man is brought to the emergency department for evaluation of confusion. The patient has complained to
More informationAbstract. Introduction
Clinical Features and Outcome of Surgery in 30 Patients with Acromegaly A. Chandna, N. Islam, A. Jabbar, L. Zuberi, N. Haque Endocrinology Section, Department of Medicine, Aga Khan University Hospital,
More informationEvaluation of Endocrine Tests B: screening for hypercortisolism
O R I G I N A L A R T I C L E Evaluation of Endocrine Tests B: screening for hypercortisolism F. Holleman 1*, E. Endert 2, M.F. Prummel 1, M. van Vessem-Timmermans 1, W.M. Wiersinga 1, E. Fliers 1 1 Department
More informationACUTE SEVERE CUSHING SYNDROME: NOT ALWAYS ECTOPIC ACTH SYNDROME
Case Report ACUTE SEVERE CUSHING SYNDROME: NOT ALWAYS ECTOPIC ACTH SYNDROME Carlos Tavares Bello, MD 1 ; Inês Gil, MD 2 ; Filipa Alves Serra, MD 3 ; João Sequeira Duarte 1 ABSTRACT Objective: Cushing syndrome
More informationPituitary, Parathyroid Pheochromocytomas & Paragangliomas: The 4 Ps of NETs
Pituitary, Parathyroid Pheochromocytomas & Paragangliomas: The 4 Ps of NETs Shereen Ezzat, MD, FRCP(C), FACP Professor Of Medicine & Oncology Head, Endocrine Oncology Princess Margaret Hospital/University
More informationBrain Tumors. Andrew J. Fabiano, MD FAANS. Associate Professor of Neurosurgery Roswell Park Cancer Institute SUNY at Buffalo School of Medicine
Brain Tumors Andrew J. Fabiano, MD FAANS Associate Professor of Neurosurgery Roswell Park Cancer Institute SUNY at Buffalo School of Medicine Brain Tumors Brain Tumor Basics Types of Tumors Cases Brain
More information