Novel Insights in the Management of Cushing s Syndrome

Transcription

1 Novel Insights in the Management of Cushing s Syndrome 1st ENEA Workshop, Napoli, Italy, December 4 6, 2009 Editors Annamaria Colao, Napoli, Italy Rolf Gaillard, Lausanne, Switzerland 25 figures, 6 in color, and 22 tables, 2010 Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney

2 Important Notice This supplement is sponsored by Novartis Pharmaceuticals Corporation. The sponsor does not endorse the use of its products in any way inconsistent with approval by appropriate regulatory agencies. Any liability of the sponsor for the content of papers presented is hereby expressly excluded. Product information must be consulted for approved usage. S. Karger Medical and Scientific Publishers Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney Disclaimer The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center (see General Information ). Copyright 2010 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISBN e-isbn

3 Vol. 92, Suppl. 1, 2010 Contents 1 Epidemiology of Cushing s Syndrome Steffensen, C.; Bak, A.M.; Zøylner Rubeck, K.; Jørgensen, J.O.L. (Aarhus) 6 Genetics of Cushing s Syndrome Yaneva, M.; Vandeva, S. (Sofia/Liège); Zacharieva, S. (Sofia); Daly, A.F.; Beckers, A. (Liège) 11 Role of Somatostatin Receptors in Normal and Tumoral Pituitary Corticotropic Cells Hofland, L.J.; Lamberts, S.W.J.; Feelders, R.A. (Rotterdam) 17 Role of Dopamine Receptors in Normal and Tumoral Pituitary Corticotropic Cells and Adrenal Cells Boschetti, M.; Gatto, F.; Arvigo, M.; Esposito, D.; Rebora, A.; Talco, M.; Albertelli, M.; Nazzari, E.; Goglia, U.; Minuto, F.; Ferone, D. (Genova) 23 Role of the PPAR-γ System in Normal and Tumoral Pituitary Corticotropic Cells and Adrenal Cells Mannelli, M.; Cantini, G.; Poli, G.; Mangoni, M.; Nesi, G.; Canu, L.; Rapizzi, E.; Borgogni, E.; Ercolino, T.; Piccini, V.; Luconi, M. (Florence) 28 Role of the mtor Pathway in Normal and Tumoral Adrenal Cells De Martino, M.C. (Rotterdam/Naples); van Koetsveld, P.M. (Rotterdam); Pivonello, R. (Naples); Hofland, L.J. (Rotterdam) 35 Novel Insights in the Diagnosis of Cushing s Syndrome Alexandraki, K.I.; Grossman, A.B. (London) 44 Hypertension in Cushing s Syndrome: From Pathogenesis to Treatment Cicala, M.V.; Mantero, F. (Padua) 50 Cardiovascular Disease in Cushing s Syndrome: Heart versus Vasculature De Leo, M.; Pivonello, R.; Auriemma, R.S.; Cozzolino, A.; Vitale, P.; Simeoli, C.; De Martino, M.C.; Lombardi, G.; Colao, A. (Naples) 55 Coagulopathy in Cushing s Syndrome Trementino, L.; Arnaldi, G.; Appolloni, G. (Ancona); Daidone, V.; Scaroni, C.; Casonato, A. (Padua); Boscaro, M. (Ancona) 60 Skeletal Diseases in Cushing s Syndrome: Osteoporosis versus Arthropathy Kaltsas, G.; Makras, P. (Athens) 65 Neuropsychiatric Disorders in Cushing s Syndrome Pereira, A.M.; Tiemensma, J.; Romijn, J.A. (Leiden) 2010 S. Karger AG, Basel Access to full text and tables of contents, including tentative ones for forthcoming issues: /nen_issues

4 71 Mortality in Cushing s Disease Clayton, R.N. (Stoke on Trent) 77 Pathophysiology of Diabetes Mellitus in Cushing s Syndrome Pivonello, R.; De Leo, M.; Vitale, P.; Cozzolino, A.; Simeoli, C.; De Martino, M.C.; Lombardi, G.; Colao, A. (Naples) 82 Management of Diabetes Mellitus in Cushing s Syndrome Munir, A.; Newell-Price, J. (Sheffield) 86 Pathophysiology of Dyslipidemia in Cushing s Syndrome Arnaldi, G.; Scandali, V.M.; Trementino, L.; Cardinaletti, M.; Appolloni, G.; Boscaro, M. (Ancona) 91 Management of Dyslipidemia in Cushing s Syndrome Greenman, Y. (Tel Aviv) 96 Metabolic Syndrome in Cushing s Syndrome Chanson, P.; Salenave, S. (Le Kremlin-Bicêtre) 102 Pituitary Surgery for Cushing s Disease Buchfelder, M.; Schlaffer, S. (Erlangen) 107 Pituitary Radiotherapy for Cushing s Disease Losa, M.; Picozzi, P.; Redaelli, M.G.; Laurenzi, A.; Mortini, P. (Milano) 111 Medical Treatment of Cushing s Syndrome: Adrenal-Blocking Drugs and Ketaconazole Feelders, R.A.; Hofland, L.J.; de Herder, W.W. (Rotterdam) 116 Medical Treatment in Cushing s Syndrome: Dopamine Agonists and Cabergoline. Petrossians, P.; Thonnard, A.-S.; Beckers, A. (Liège) 120 Medical Treatment of Cushing s Disease: Somatostatin Analogues and Pasireotide Pedroncelli, A.M. (Basle) 125 Medical Treatment of Cushing s Syndrome: Glucocorticoid Receptor Antagonists and Mifepristone Castinetti, F.; Conte-Devolx, B.; Brue, T. (Marseille) 131 Author Index 132 Subject Index IV Contents

5 Published online: September 10, 2010 Preface The current issue of Neuroendocrinology is composed of a collection of minireviews dedicated to the different topics discussed in the lectures and symposia of the first ENEA Workshop titled Novel insight in the management of Cushing s syndrome, which was held in Naples on December 4 6, This workshop represented the first of a series of special meetings dedicated to improve the knowledge on neuroendocrine diseases and to implement collaboration among groups of neuroendocrinologists and associated specialists around the world. Of several different objectives of this initiative, one is to produce shared guidelines as well as consensus statements on the diagnosis and treatment of specific diseases in the field of neuroendocrinology. Cushing s syndrome is a rare endocrine disease which has become extremely attractive due to its complexity and its multidisciplinary management that needs the cooperation of clinical and basic endocrinologists, surgeons, internists, cardiologists, immunologists, rheumatologists, orthopedists, psychiatrists, pharmacologists, and colleagues trained in imaging techniques. The richness of this publication can be seen from the variety of the arguments discussed during the workshop by some of the most notable neuroendocrinologists and researchers in the world. Starting with cellular biology and ending with the new medical therapies and passing through the diagnostic procedures and complications, the articles include information from all the fields of analysis of this complicated disease. The collection of articles can be divided into five categories. First, there is an important review on the epidemiology of Cushing s syndrome. The second section is dedicated to molecular biology, starting with the genetics of the syndrome and continuing with a description of the expression and role of various receptors and molecular pathways in normal and tumoral pituitary and adrenal cells, such as somatostatin and dopamine receptors, PPAR and the mtor pathway, representing the basis for therapeutic approaches. The third section contains novel insights into the diagnosis of Cushing s syndrome, either of pituitary or of adrenal or ectopic origin. The fourth section concerns prevention and cure of systemic complications of the disease, including hypertension, cardiovascular disease, coagulopathy, skeletal diseases and mental disturbances; in addition, there are profound analyses on the pathophysiology of metabolic complications like diabetes mellitus, dyslipidemia and the metabolic syndrome. The last section is dedicated to novel approaches in the treatment of Cushing s syndrome, starting from the commonly recognized first-line therapy, neurosurgery, and continuing with radiotherapy and medical therapy consisting of the use of different molecules such as adrenalblocking agents like ketoconazole, dopamine agonists like cabergoline, and somatostatin analogues like the new multiligand pasireotide and the glucocorticoid receptor antagonist mifepristone. The variety of the articles demonstrates the complexity of Cushing s syndrome in its clinical presentation, diagnostic approach and multimodal treatment. However, it is a good representation of the dynamism of the ENEA behind the finalization of this book, showing that only open, enthusiastic and vital minds can help modern researchers in endocrinology manage the input of increasing knowledge on the endocrine system in order to help them ameliorate the patient s quality of life. Enjoy your reading Annamaria Colao, Rolf Gaillard 2010 S. Karger AG, Basel Accessible online at: /nen