Medical therapy in severe hypercortisolism

Marques, Júlia Vieira Oberger; Boguszewski, César Luiz

doi:10.1016/j.beem.2021.101487

Cited by 10 publications

(7 citation statements)

References 35 publications

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“…The antifungal drug, ketoconazole, is a glucocorticoid receptor antagonist, which can inhibit the biosynthesis of the adrenal gland and reduce the level of endogenous cortisol. 31 In a retrospective cohort study with a total of 41 naive CSC eyes, it was found that ketoconazole treatment could shorten the disease duration through promoting SRF absorbtion. 32 Another effective glucocorticoid antagonist, mifepristone, was used in CSC treatment.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

Zhao¹,

Huang²,

Chen³

et al. 2022

TCRM

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Background: Central serous chorioretinopathy (CSC) is preferential cocurated in males, however the associations between sex hormones and CSC incidence or progression remains unclear. The sex hormone concentration assessments in CSC cases and healthy controls will update the knowledge in CSC management. Methods: This case-control study included 59 CSC cases and 30 healthy controls, from January 2019 to December 2020. The CSC cases would be defined as spontaneous resolved if the subretinal fluid were absorbed within three months. The concentrations of total testosterone (TT), free testosterone (FT), estradiol (E2), sex hormone-binding globulin (SHBG), progesterone, leuteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S) were detected in all the participants. The relationships between sex hormone concentrations and CSC-related characteristics were analyzed with Pearson correlation analyses. Results: Significantly increased TT, FT, FT/E2 ratio, SHBG concentrations as well as decreased DHEA-S level were detected in nonresolved CSC group compared with the control group. Comparing with the resolved ones, it was found that TT, FT and SHBG concentrations were increased in the non-resolved CSC. A significant positive correlation between TT concentrations and CMT (R 2 =0.168, P=0.031) as well as SRF height (R 2 =0.146, P=0.045) were detected in the non-solved CSC group. Conclusion: Different concentrations of TT, FT, FT/E2 ratio, DHEA-S and SHBG were detected in resolved and non-resolved CSC cases. Sex hormones were related to CSC symptom durations and related parameters.

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Section: Discussionmentioning

confidence: 99%

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

Zhao¹,

Huang²,

Chen³

et al. 2022

TCRM

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“…Multiple serial tests of both UFC and LNSC are used to monitor treatment outcomes. 158,232,233 A brief summary of Workshop discussions about how to best incorporate each of the different treatment options is presented below and in Panel 2.…”

Section: Medical Therapy: Clinical Considerations and Recommendationsmentioning

confidence: 99%

Consensus on diagnosis and management of Cushing's disease: a guideline update

Fleseriu

Auchus

Bancos

et al. 2021

The Lancet Diabetes & Endocrinology

487

538

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“…A glucocorticoid receptor antagonist, mifepristone, has a rapid action as well, but its use has been limited because of difficulties in monitoring its efficacy and safety. Other slow-acting cortisol-lowering medications (mitotane, cabergoline, and pasireotide) might be candidates in the therapeutic options [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Ectopic ACTH-producing neuroendocrine tumor occurring with large recurrent metastatic pheochromocytoma: a case report

Saishouji

Maeda²,

Hamada³

et al. 2022

BMC Endocr Disord

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Background Ectopic ACTH-dependent Cushing syndrome is rarely caused by pheochromocytoma (PCC). Glucocorticoid-regulated positive feedback loops in ACTH and catecholamines were proposed in some similar cases. Case presentation We present here an 80-year-old man who had previously undergone surgery for a left adrenal PCC and newly developed severe hypertension, hypokalemia, and typical Cushingoid manifestations. Investigations revealed hyperglycemia, hypokalemia, and extremely high catecholamines and their metabolites, ACTH and cortisol. Imaging modalities showed a recurrent large left adrenal mass positively visualized with 123I-metaiodobenzylguanidine as well as somatostatin receptor scintigraphy. Surgical interventions were not indicated; thus, metyrapone, phentolamine, and doxazocin were initiated, which successfully controlled his symptoms and biochemical conditions. With the evidence that metyrapone administration decreased ACTH and catecholamine levels, the existence of positive feedback loops was speculated. During the terminal stages of the disease, additional metyrosine treatment successfully stabilized his physiological and biochemical conditions. Upon the patient’s death, pathological autopsy was performed. Immunohistochemical analysis indicated that the tumor appeared to be co-positive with tyrosine hydroxylase (TH) as well as ACTH in most tumor cells in both PCC and liver metastasis. Most cells were clearly positive for somatostatin receptor 2 staining in the membrane compartment. The dense immunostaining of ACTH, TH, dopamine-β-hydroxylase and the large tumor size with positive feedback loops may be correlated with high levels of ACTH and catecholamines in the circulation. Conclusions We experienced a case of severe ectopic ACTH producing the largest reported recurrent malignant left PCC with liver metastases that presented positive feedback loops in the ACTH/cortisol and catecholamine/cortisol axes. Clinicians should be aware of the paradoxical response of ACTH on metyrapone treatment and possible steroid-induced catecholamine crisis.

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Medical therapy in severe hypercortisolism

Cited by 10 publications

References 35 publications

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

Consensus on diagnosis and management of Cushing's disease: a guideline update

Ectopic ACTH-producing neuroendocrine tumor occurring with large recurrent metastatic pheochromocytoma: a case report

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