Análisis de los resultados del tratamiento de la enfermedad de Cushing en los hospitales de Castilla-La Mancha

Huguet, Isabel; Aguirre, Miguel; Vicente, Almudena; Alramadan, Mubarak; Quiroga, Ivan; Silva, Júlia; Lamas, Cristina

doi:10.1016/j.endonu.2015.02.007

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…The study by Huguet et al. ( 23 ) was excluded from the analysis of the “no biochemical control” variable for not mentioning non-remission as a possible outcome.…”

Section: Resultsmentioning

confidence: 99%

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Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery: systematic review and meta-analysis

et al. 2023

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IntroductionThe first-line treatment for Cushing’s disease is transsphenoidal surgery for pituitary tumor resection. Ketoconazole has been used as a second-line drug despite limited data on its safety and efficacy for this purpose. The objective of this meta-analysis was to analyze hypercortisolism control in patients who used ketoconazole as a second-line treatment after transsphenoidal surgery, in addition to other clinical and laboratory criteria that could be related to therapeutic response.MethodsWe searched for articles that evaluated ketoconazole use in Cushing’s disease after transsphenoidal surgery. The search strategies were applied to MEDLINE, EMBASE, and SciELO. Independent reviewers assessed study eligibility and quality and extracted data on hypercortisolism control and related variables such as therapeutic dose, time, and urinary cortisol levels.ResultsAfter applying the exclusion criteria, 10 articles (one prospective and nine retrospective studies, totaling 270 patients) were included for complete data analysis. We found no publication bias regarding reported biochemical control or no biochemical control (p = 0.06 and p = 0.42 respectively). Of 270 patients, biochemical control of hypercortisolism occurred in 151 (63%, 95% CI 50-74%) and no biochemical control occurred in 61 (20%, 95% CI 10-35%). According to the meta-regression, neither the final dose, treatment duration, nor initial serum cortisol levels were associated with biochemical control of hypercortisolism.ConclusionKetoconazole can be considered a safe and efficacious option for Cushing’s disease treatment after pituitary surgery.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#searchadvanced, (CRD42022308041).

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“…The study by Huguet et al. ( 23 ) was excluded from the analysis of the “no biochemical control” variable for not mentioning non-remission as a possible outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Only five papers mentioned how many patients underwent radiotherapy during treatment with ketoconazole; at least 59 patients (21%) received radiotherapy treatment concomitantly or subsequent to ketoconazole ( 10 , 22 , 23 , 27 , 28 ).…”

Section: Resultsmentioning

confidence: 99%

Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery: systematic review and meta-analysis

et al. 2023

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Outcomes of pituitary surgery for Cushing’s disease: a systematic review and meta-analysis

et al. 2020

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Longitudinal Monitoring of Hair Cortisol Using Liquid Chromatography–Mass Spectrometry to Prevent Hypercortisolism in Patients Undergoing Glucocorticoid Replacement Therapy

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et al. 2022

Therapeutic Drug Monitoring

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Objective:Currently available methods for endogenous cortisol monitoring in patients with hormonal insufficiency rely on measurements of plasma levels only at a single time point; thus, any kind of chronic exposure to cortisol is challenging to evaluate because it requires collecting samples at different time points. Hair cortisol levels acquired longitudinally better reflected chronic exposure (both cortisol synthesis and deposition) and may significantly contribute to better outcomes in glucocorticoid replacement therapies.Design:Twenty-two patients on cortisol substitution therapy were monitored for plasma, urinary, and hair cortisol levels for 18 months to determine whether hair cortisol may serve as a monitoring option for therapy setting and adjustment.Methods:Plasma and urinary cortisol levels were measured using standardized immunoassay methods, and segmented (∼1 cm) hair cortisol levels were monitored by liquid chromatography coupled to mass spectrometry. A log-normal model of the changes over time was proposed, and Bayesian statistics were used to compare plasma, urinary, and hair cortisol levels over 18 months.Results and conclusions:Hair cortisol levels decreased over time in patients undergoing substitutional therapy. The residual variance of hair cortisol in comparison to plasma or urinary cortisol levels was much lower. Thus, longitudinal monitoring of hair cortisol levels could prove beneficial as a noninvasive tool to reduce the risk of overdosing and improve the overall patient health.

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Análisis de los resultados del tratamiento de la enfermedad de Cushing en los hospitales de Castilla-La Mancha

Cited by 5 publications

References 16 publications

Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery: systematic review and meta-analysis

Ketoconazole as second-line treatment for Cushing’s disease after transsphenoidal surgery: systematic review and meta-analysis

Outcomes of pituitary surgery for Cushing’s disease: a systematic review and meta-analysis

Longitudinal Monitoring of Hair Cortisol Using Liquid Chromatography–Mass Spectrometry to Prevent Hypercortisolism in Patients Undergoing Glucocorticoid Replacement Therapy

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