Medical management of Cushing's disease: When and how?

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. [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

“…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.

“…This article is part of an update series on the diagnosis and treatment of Cushing's syndrome. [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]…”

Section: Inter-gender Differences In the Distribution Of Symptomsmentioning

confidence: 99%

Clinical presentation and etiology of Cushing's syndrome: Data from ERCUSYN

Valassi

2022

This review presents the data on clinical presentation at diagnosis in 1564 patients included in the European Registry on Cushing's syndrome (ERCUSYN), of whom 1045 (67%) had pituitary‐dependent Cushing's syndrome (CS) (PIT‐CS), 385 (25%) had adrenal dependent CS (ADR‐CS) and 89 (5%) had ectopic adrenocorticotropic hormone syndrome (ECT‐CS). The most frequent symptoms in the overall series were weight gain (83%), hypertension (79%), skin alterations (76%) and myopathy (70%). Diabetes mellitus was present in 32% and depression in 35% of patients. Skin alterations, menstrual irregularities and reduced libido were more prevalent in PIT‐CS patients compared to ADR‐CS patients, whereas patients with ECT‐CS more frequently had diabetes mellitus, myopathy, hirsutism and vertebral fractures compared to the other etiologies, consistent with a more severe clinical scenario. Reduced libido and bone fractures were more prevalent in men compared to women. Quality of life was poor at diagnosis, irrespective of the etiology of CS, and also associated with the presence of depression at baseline. A delay of 2 years between the onset of symptoms and diagnosis was also observed, with a high number of specialists consulted, who often missed the correct diagnosis. To develop strategies aimed at shortening the time elapsed to diagnosis, it is important to rapidly start treatment and reduce the burden of the disease on patient psychophysical health and longevity.