Prolonged Treatment of Cushing's Disease by Ketoconazole

Sonino, Nicoletta; Boscaro, Marco; Merola, G.; Mantero, Franco

doi:10.1210/jcem-61-4-718

Cited by 112 publications

(48 citation statements)

References 16 publications

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“…Comparison with other treatments is difficult because various criteria of remission were used or insufficient data were available in the previous studies: anticortisolic drugs, like ketoconazole or mitotane (29,30), have a wide range of efficacy, but they expose patients to dangerous hepatic cytolysis (5). The efficacy of glitazones is still discussed, due to several conflicting studies: pioglitazone yielded disappointing results, while rosiglitazone normalized UFC in 6 out of 14 patients with CD (31).…”

Section: Discussionmentioning

confidence: 99%

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Castinetti¹,

Nagai²,

Dufour³

et al. 2007

eur j endocrinol

161

118

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Objective: Though transsphenoidal surgery remains the first-line treatment of Cushing's disease, recurrence occurs frequently. Conventional radiotherapy and anticortisolic drugs both have adverse effects. Stereotactic radiosurgery needs to be evaluated more precisely. The aim of this study was to determine long-term hormonal effects and tolerance of gamma knife (GK) radiosurgery in Cushing's disease. Design: Forty patients with Cushing's disease treated by GK were prospectively studied over a decade, with a mean follow-up of 54.7 months. Eleven of them were treated with GK as a primary treatment. Methods: Radiosurgery was performed at the Department of Functional Neurosurgery of Marseille, France, using the Leksell Gamma Unit B and C models. Median margin dose was 29.5 Gy. Patients were considered in remission if they had normalized 24-h free urinary cortisol and suppression of plasma cortisol after low-dose dexamethasone suppression test. Results: Seventeen patients (42.5%) were in remission after a mean of 22 months (range 12-48 months). The two groups did not differ in terms of initial hormonal levels. Target volume was significantly higher in uncured than in remission group (909.8 vs 443 mm 3 , PZ0.038). We found a significant difference between patients who were on or off anticortisolic drugs at the time of GK (20 vs 48% patients in remission respectively, PZ0.02). Conclusion: With 42% of patients in remission after a median follow-up of 54 months, GK stereotactic radiosurgery, especially as an adjunctive treatment to surgery, may represent an alternative to other therapeutic options in view of their adverse effects.European Journal of Endocrinology 156 91-98

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Section: Discussionmentioning

confidence: 99%

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Castinetti¹,

Nagai²,

Dufour³

et al. 2007

eur j endocrinol

161

118

View full text Add to dashboard Cite

show abstract

“…These include menstrual irregularities, gynecomastia, azoospermia, adrenal insufficiency, hypertension, and fluid retention [7]. Because ketoconazole inhibits steroid biosynthesis in patients, as it does in fungi, by inhibiting cytochrome P450-dependent enzyme synthesis, it is reasonable that ketoconazole is associated with a variety of hormonal disorders and that a daily dose of 800 mg of ketoconazole has been used to suppress plasma cortisol levels in patients with Cushing's disease [8]. Subsequently, newer azole antifungals have replaced ketoconazole because of improved efficacy, minimal hormonal effects, and the possibility of intravenous administration.…”

Section: Discussionmentioning

confidence: 99%

Acute adrenal failure associated with fluconazole after administration of high‐dose cyclophosphamide

et al. 2001

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“…However, during the localization diagnosis period, even in occult cases, given the severity of the case, clinical treatment was necessary with cortisol synthesis blockers, ketoconazole being the most often used due to its efficacy (34). An example of such efficacy was the normalization of urinary cortisol values, which were very high in patient #24.…”

Section: Treatmentmentioning

confidence: 99%

Ectopic ACTH syndrome: our experience with 25 cases

Fragoso²,

et al. 2006

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Objective: Ectopic ACTH syndrome (EAS) occurs in about 5-10% of all patients with ACTH-dependent hypercortisolism with most of them caused by intrathoracic neoplasms. It may be associated with overt malignancies or with occult and indolent tumors. We assessed the accuracy of dynamic tests, inferior petrosal sinus sampling (IPSS) using desmopressin, and imaging in the work-up diagnosis of EAS. Design and subjects: Tumor markers, imaging, and outcome data from 25 patients (13F/12M) aged 18-72 years. High dexamethasone suppression test (HDDST), desmopressin test, GHRP-6 test, corticotropin-releasing hormone (CRH) test, IPSS, computed tomography (CT), magnetic resonance imaging (MRI), and 111 In-pentetreotide scintigraphy were revised. Results: In 5 out of 20 patients HDDST was positive. In 13 patients who underwent desmopressin test, ACTH-and cortisol-positive responses were seen in six and five patients respectively. GHRP-6 test was positive in two out of three cases. Two patients underwent CRH test with negative response. In the seven patients submitted to IPSS using desmopressin in six of them, none had ACTH gradients. CT was positive in 15 out of 21 patients and MRI in 8 out of 17 cases.111 In-pentetreotide scintigraphy was positive in three out of five patients. Fourteen patients had intrathoracic tumors, five had pheochromocytomas, three had pancreatic tumors, one had a glomic tumor, and had three occult tumors. Six out of 11 patients with metastasis died and 3 others without metastasis died. Conclusions: IPSS with desmopressin was helpful for differential diagnosis. Patients initially harboring occult carcinoids may also exhibit severe hypercortisolism and those harboring tymic carcinoids had poor prognoses when compared with bronchial carcinoids and pheocromocytomas.European Journal of Endocrinology 155 725-733

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Prolonged Treatment of Cushing's Disease by Ketoconazole

Cited by 112 publications

References 16 publications

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease

Acute adrenal failure associated with fluconazole after administration of high‐dose cyclophosphamide

Ectopic ACTH syndrome: our experience with 25 cases

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