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Article Dans Une Revue European Journal of Endocrinology Année : 2018

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

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

Résumé

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 et versions

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

Identifiants

Citer

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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