Long‐term follow‐up and predictors of recurrence of Cushing's disease

Prolonged excess of glucocorticoids (GCs) has adverse systemic effects leading to significant morbidities and an increase in mortality. Metabolic alterations associated with the high level of the GCs are key risk factors for the poor outcome. These include GCs causing excess gluconeogenesis via upregulation of key enzymes in the liver, a reduction of insulin sensitivity in skeletal muscle, liver and adipose tissue by inhibiting the insulin receptor signalling pathway, and inhibition of insulin secretion in beta cells leading to dysregulated glucose metabolism. In addition, chronic GC exposure leads to an increase in visceral adipose tissue, as well as an increase in lipolysis resulting in higher circulating free fatty acid levels and in ectopic fat deposition.Remission of hypercortisolism improves these metabolic changes, but very often does not result in full resolution of the abnormalities. Therefore, long-term monitoring of metabolic variables is needed even after the resolution of the excess GC levels.

“…This article is part of an update series on the diagnosis and treatment of Cushing's syndrome. [113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129]…”

Section: Discussionmentioning

confidence: 99%

Glucose and lipid metabolism abnormalities in Cushing's syndrome

Salehidoost

Korbonits

2022

“…This article is part of an update series on the diagnosis and treatment of Cushing's syndrome. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]…”

Section: Discussionmentioning

confidence: 99%

Role of radiosurgery in the treatment of Cushing's disease

Losa

Albano

Bailo

et al. 2022

Radiotherapy is a useful adjuvant treatment for patients with Cushing's disease that is not cured by surgery. In particular, Gamma Knife radiosurgery (GKRS) has been increasingly used worldwide as the preferred radiation technique in patients with persistent or recurrent Cushing's disease. The most widely accepted criterion for hormonal remission after GKRS is normalization of urinary free cortisol (UFC) levels.

“…This article is part of an update series on the diagnosis and treatment of Cushing's syndrome. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]…”

Section: Discussionmentioning

confidence: 99%

Pituitary MRI in Cushing's disease ‐ an update

Bonneville

Potorac

Pétrossians

et al. 2022

Pituitary MRI is essential in the diagnosis of ACTH-dependent Cushing's syndrome, but its results are inconsistent. The demonstration of a sellar image compatible with the diagnosis of corticotropinoma varies from 40% to 90%, depending on the centre where the imaging is performed. In fact, the expertise of the neuroradiologist, use of a Tesla 3.0 MRI and choice of sequences are fundamental. The T2 and 3D gradient echo sequences after gadolinium injection are the most informative and today allow the detection of macro-and microadenomas in almost all cases. The diagnosis of numerous picoadenomas (<3-4 mm) is more challenging. The 2D and 3D spin echo or delayed T1 SE or FLAIR sequences after gadolinium can be used as a complement or to confirm a suspicious image. Characterization of corticotropinomas remains problematic. However, the correct assessment of so-called incidentalomas by recognizing artifacts, anatomical variants and frequent Rathke's cleft cysts eliminates around 90% of the incidentalomas that mimic pituitary adenomas, as repetitively reported in the literature. For the time being, there is reason to believe that hybrid imaging combining PET and MRI such as 11C-methionine PET coregistered with volumetric MRI will solve the diagnosis of corticotropinomas in the near future.