Preoperative medical treatment in Cushing's syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN - Archive ouverte HAL Access content directly
Journal Articles European Journal of Endocrinology Year : 2018

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

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Elena Valassi
  • Function : Author
Holger Franz
  • Function : Author
Richard A. Feelders
  • Function : Author
Romana Netea-Maier
  • Function : Author
Stylianos Tsagarakis
  • Function : Author
Susan M. Webb
  • Function : Author
Maria Yaneva
  • Function : Author
Martin Reincke
Michael Droste
  • Function : Author
Irina Komerdus
  • Function : Author
Dominique Maiter
  • Function : Author
Darko Kastelan
  • Function : Author
Philippe Chanson
Marija Pfeifer
  • Function : Author
Christian J. Strasburger
  • Function : Author
Miklos Toth
  • Function : Author
Olivier Chabre
  • Function : Author
Michal Krsek
  • Function : Author
Carmen Fajardo
  • Function : Author
Marek Bolanowski
  • Function : Author
Alicia Santos
  • Function : Author
Peter J. Trainer
  • Function : Author
John A. H. Wass
  • Function : Author
Antoine Tabarin
  • Function : Author
Ercusyn Study Grp
  • Function : Author

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.

Dates and versions

hal-01876275 , version 1 (18-09-2018)

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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, 2018, 178 (4), pp.399-409. ⟨10.1530/EJE-17-0997⟩. ⟨hal-01876275⟩

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