Hormone‐secreting adrenal tumours cause severe hypertension and high rates of poor pregnancy outcome; a <scp>UK</scp> Obstetric Surveillance System study with case control comparisons

Quartermaine, G; Lambert, Kimberley; Rees, K. R.; Seed, Paul; Dhanjal, M.; Knight, Marian; McCance,; Williamson, Catherine

doi:10.1111/1471-0528.14918

Cited by 19 publications

(13 citation statements)

References 25 publications

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“…Another reason might be the kind of treatment that was performed. The lower survival rate in patients >50 years can be due to the fact that older patients are often treated by radiotherapy rather than by surgery [33]. …”

Section: Discussionmentioning

confidence: 99%

The Impact of Age on the Prognosis of Vulvar Cancer

Hami

Lampe²,

Mallmann

et al. 2018

Oncol Res Treat

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Introduction: Younger women are particularly affected by the increase in the incidence of vulvar cancer. The purpose of this study was to investigate how clinical characteristics differ depending on the patient´s age and what role the age of initial diagnosis plays in the prognosis. Patients andMethods: Included patients were divided into groups aged below or above 50 years. The disease-free survival (DFS) was calculated and a multivariate discriminant analysis was conducted. Results: Of the 300 patients, 79 were ≤50 years and 221 were >50 years. The median age was 64 years (19-96 years). There were no differences between the groups regarding lymph node (LN) status and distant metastasis, but T1 tumours were more frequent in patients ≤50 years (77% vs. 62%, p = 0.02). The DFS only differed between the groups when there were no LN metastases. The nodal status was the predominant prognostic factor for the DFS regardless of age. In node-free patients, the 5-year DFS was 49% for the ≤50 years group and 89% for the >50 years group (p = 0.008), whereas there was no difference if a LN was involved. Conclusion: In node-free patients, the risk for recurrence is lower for patients older than 50 years.

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Section: Discussionmentioning

confidence: 99%

The Impact of Age on the Prognosis of Vulvar Cancer

Hami

Lampe²,

Mallmann

et al. 2018

Oncol Res Treat

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“…PA in the setting of pregnancy PA is uncommon in pregnancy and fewer than 50 cases have been reported in the literature; most pregnant patients with PA have APA [180][181][182][183][184][185]. PA in pregnancy can lead to preterm delivery, intrauterine growth retardation, placental abruption and intrauterine foetal demise [185][186][187]. An unusual feature of PA during pregnancy is that the degree of disease may be either improved or aggravated.…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

2018

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Primary aldosteronism (PA), the most common form of secondary hypertension, can be either surgically cured or treated with targeted pharmacotherapy. PA is frequently undiagnosed and untreated, leading to aldosterone‐specific cardiovascular morbidity and nephrotoxicity. Thus, clinicians should perform case detection testing for PA at least once in all patients with hypertension. Confirmatory testing is indicated in most patients with positive case detection testing results. The next step is to determine whether patients with confirmed PA have a disease that can be cured with surgery or whether it should be treated medically; this step is guided by computed tomography scan of the adrenal glands and adrenal venous sampling. With appropriate surgical expertise, laparoscopic unilateral adrenalectomy is safe, efficient and curative in patients with unilateral adrenal disease. In patients who have bilateral aldosterone hypersecretion, the optimal management is a low‐sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to maintain a high–normal serum potassium concentration without the aid of oral potassium supplements.

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“…To date, less than 200 cases of CS during pregnancy have been reported in the literature with adrenal adenoma reported to be the most frequent aetiology in 40-60% of cases 35,36 followed by pituitary adenomas, which represent 15-40% of cases. Although some series describe adrenal carcinomas (ACC) as responsible for CS in less than 10% of cases during pregnancy, 35 new evidence suggested a higher percentage (13%) of prevalence.…”

Section: Cushing Syndrome During Pregnancymentioning

confidence: 99%

Glucocorticoids in pregnancy

Pofi

Tomlinson

2019

Obstet Med

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The physiological changes that occur during pregnancy include altered regulation of the hypothalamo-pituitary-adrenal axis. The fetoplacental unit plays a major role in this, together with alteration of circulating cortisol-binding globulin levels, with a net effect to increase both total and free cortisol levels. Importantly, there are several pathological conditions that require steroid treatment or replacement during pregnancy, and optimizing therapy is clearly crucial. The potential for acute and chronic adverse effects that can impact upon both the mother and the fetus makes the decision of how and when to instigate steroid therapy particularly challenging. In this review, we describe the physio-pathological changes to the hypothalamo-pituitary-adrenal axis that occur during pregnancy, tools to assess endogenous glucocorticoid reserve as well as discuss treatment strategies and the potential for the development of adverse events.

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Hormone‐secreting adrenal tumours cause severe hypertension and high rates of poor pregnancy outcome; a UK Obstetric Surveillance System study with case control comparisons

Abstract: Study of hormone-secreting adrenal tumours in pregnancy linked with high BP and high rates of fetal morbidity.

Cited by 19 publications

References 25 publications

The Impact of Age on the Prognosis of Vulvar Cancer

The Impact of Age on the Prognosis of Vulvar Cancer

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

Glucocorticoids in pregnancy

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