Adrenalectomy in ectopic Cushing’s syndrome: A retrospective cohort study from a tertiary care centre

Abstract

Neuroendocrine neoplasms (NENs) causing ectopic Cushing's syndrome (ECS) are rare and challenging to treat. In this retrospective cohort study, we aimed to evaluate different approaches for bilateral adrenalectomy (BA) as a treatment option in ECS. Fifty‐three patients with ECS caused by a NEN (35 females/18 men; mean ± SD age: 53 ± 15 years) were identified from medical records. Epidemiological and clinical parameters, survival, indications for surgery and timing, as well as duration of surgery, complications and surgical techniques, were collected and further analysed. The primary tumour location was thorax (n = 30), pancreas (n = 14) or unknown (n = 9). BA was performed in 37 patients. Median time from diagnosis of ECS to BA was 2 months (range 1–10 months). Thirty‐two patients received different steroidogenesis inhibitors before BA to control hypercortisolaemia. ECS resolved completely after surgery in 33 patients and severe peri‐ or postoperative complications were detected in 12 patients. There were fewer severe complications in the endoscopic group compared to open surgery (p = .030). Posterior retroperitoneoscopic BA performed simultaneously by a two surgeon approach had the shortest operating time (p = .001). Despite the frequent use of adrenolytic treatment, BA was necessary in a majority of patients to gain control over ECS. Complication rate was high, probably as a result of the combination of metastatic disease and metabolic disorders caused by high cortisol levels. The two surgeon approach BA may be considered as the method of choice in ECS compared to other BA approaches as a result of fewer complications and a shorter operating time.

Normalizing the Optical Signal Enables Robust Assays with Lateral Flow Biosensors

“… 35 This pattern can be perturbed in response to external or internal stimuli, such as exercise, mental stress, and infection; monitoring CTS levels thus can inform person’s physiological homeostasis and help diagnosing hormonal disorders (e.g., Cushing’s syndrome and Addison’s disease). 36 , 37 …”

“…The normal CTS level is known to display a diurnal rhythm: it rises sharply with awakening from sleep in the morning, gradually declines through the day, and reaches the lowest point in the early morning hours during sleep . This pattern can be perturbed in response to external or internal stimuli, such as exercise, mental stress, and infection; monitoring CTS levels thus can inform person’s physiological homeostasis and help diagnosing hormonal disorders (e.g., Cushing’s syndrome and Addison’s disease). , …”

Elimination of Foxo triplets following glucocorticoid incubation dampened metabolic stress and enhanced anti-viral response targets based on transcriptomic analysis

“…The notable features include weight gain accompanied by metabolic dysregulation and muscle atrophy and apparent metabolic disturbances accompanied by insulin resistance, hyperglycemia and hyperlipidemia [7][8][9][10][11][12][13][14][15]. Adrenalectomy has been shown to be an effective procedure in reducing the detrimental effects of glucocorticoid excess, but clinically it has various harmful aftermaths [16][17][18]. Previous findings from the applicant and other's labs have demonstrated Foxo1 as a major regulator of glucocorticoid action [19,20].…”

Синдром Ектопічної АКТГ (Огляд Літератури Та Випадок Із Прак Тики)

“…Зазвичай розмір її не корелює з тяжкістю симптомів, а рівень АКТГ з її агресивністю [19,21]. Водночас в середньому до 20% пухлин (8-47%), що секретують АКТГ, залишаються невиявленими («приховані», «окультні») [13,19,22]. «Прихований» EAS є однією з найбільш цікавих проблем для клінічного ендокринолога, оскільки в деяких випадках пухлину не виявляють впродовж тривалого спостереження чи навіть під час розтину.…”