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

Elena Valassi Holger Franz Thierry Brue 1, 2 Richard A. Feelders Romana Netea-Maier Stylianos Tsagarakis Susan M. Webb Maria Yaneva Martin Reincke Michael Droste Irina Komerdus Dominique Maiter Darko Kastelan Philippe Chanson Marija Pfeifer Christian J. Strasburger Miklos Toth Olivier Chabre Michal Krsek Carmen Fajardo Marek Bolanowski Alicia Santos Peter J. Trainer John A. H. Wass Antoine Tabarin Ercusyn Study Grp
1 MMG - Marseille medical genetics - Centre de génétique médicale de Marseille
2 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
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.
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https://hal-amu.archives-ouvertes.fr/hal-01876275
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Submitted on : Tuesday, September 18, 2018 - 12:21:13 PM
Last modification on : Wednesday, August 19, 2020 - 12:08:21 PM

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Elena Valassi, Holger Franz, Thierry Brue, Richard A. Feelders, Romana Netea-Maier, et al.. Preoperative medical treatment in Cushing's syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN. European Journal of Endocrinology, BioScientifica, 2018, 178 (4), pp.399-409. ⟨10.1530/EJE-17-0997⟩. ⟨hal-01876275⟩

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