Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN

Elena Valassi; Holger Franz; Thierry Brue; Richard A. Feelders; Romana Netea-Maier; Stylianos Tsagarakis; Susan M. Webb; Maria Yaneva; Martin Reincke; Michael Droste; Irina Komerdus; Dominique Maiter; Darko Kastelan; Philippe Chanson; Marija Pfeifer; Christian J. Strasburger; Miklós Tóth; Olivier Chabre; Michal Krsek; Carmen Fajardo; Marek Bolanowski; Alicia Santos; Peter J. Trainer; John A.H. Wass; Antoine Tabarin; A. Ambrogio; G. Aranda; M. Arosio; M. Balomenaki; P. Beck-Peccoz; C. Berr-Kirmair; J. Bollerslev; D. Carvalho; F. Cavagnini; E. Christ; J. Denes; C. Dimopoulou; A. Dreval; T. Dusek; E. Erdinc; J. A. Evang; J. Fazel; S. Fica; E. Ghigo; M. Goth; Y. Greenman; V. Greisa; I. Halperin; F. A. Hanzu; A. Hermus; G. Johannsson; P. Kamenicky; A. Kasperlik-Zaluska; J. Kirchner; I. Kraljevic; A. Kruszynska; I. Lambrescu; S. Lang; A. Luger; N. Marpole; S. Martin; M. Martinie; O. Moros; J. Newell-Price; M. Orbetzova; I. Paiva; F. Pecori Giraldi; A. M. Pereira; J. Pickel; V. Pirags; O. Ragnarsson; A. D. Reghina; P. Riesgo; M. Roberts; S. Roerink; O. Roig; C. Rowan; P. Rudenko; M. A. Sahnoun; J. Salvador; H. A. Sigurjonsdottir; T. Skoric Polovina; R. Smith; B. Stachowska; G. Stalla; J. Toke; E. Ubina; S. Vinay; M. Wagenmakers; S. Werner; J. Young; P. Zdunowski; K. Zopf; S. Zopp; I. Zosin

doi:10.1530/EJE-17-0997

Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN

Elena Valassi, Holger Franz, Thierry Brue, Richard A. Feelders, Romana Netea-Maier, Stylianos Tsagarakis, Susan M. Webb, Maria Yaneva, Martin Reincke, Michael Droste, Irina Komerdus, Dominique Maiter, Darko Kastelan, Philippe Chanson, Marija Pfeifer, Christian J. Strasburger, Miklós Tóth, Olivier Chabre, Michal Krsek, Carmen FajardoMarek Bolanowski, Alicia Santos, Peter J. Trainer, John A.H. Wass, Antoine Tabarin, A. Ambrogio, G. Aranda, M. Arosio, M. Balomenaki, P. Beck-Peccoz, C. Berr-Kirmair, J. Bollerslev, D. Carvalho, F. Cavagnini, E. Christ, J. Denes, C. Dimopoulou, A. Dreval, T. Dusek, E. Erdinc, J. A. Evang, J. Fazel, S. Fica, E. Ghigo, M. Goth, Y. Greenman, V. Greisa, I. Halperin, F. A. Hanzu, A. Hermus, G. Johannsson, P. Kamenicky, A. Kasperlik-Zaluska, J. Kirchner, I. Kraljevic, A. Kruszynska, I. Lambrescu, S. Lang, A. Luger, N. Marpole, S. Martin, M. Martinie, O. Moros, J. Newell-Price, M. Orbetzova, I. Paiva, F. Pecori Giraldi, A. M. Pereira, J. Pickel, V. Pirags, O. Ragnarsson, A. D. Reghina, P. Riesgo, M. Roberts, S. Roerink, O. Roig, C. Rowan, P. Rudenko, M. A. Sahnoun, J. Salvador, H. A. Sigurjonsdottir, T. Skoric Polovina, R. Smith, B. Stachowska, G. Stalla, J. Toke, E. Ubina, S. Vinay, M. Wagenmakers, S. Werner, J. Young, P. Zdunowski, K. Zopf, S. Zopp, I. Zosin

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

7 Citations (Scopus)

Abstract

© 2018 European Society of Endocrinology. Background: Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. Objective: (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). Patients and methods: 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS). Results: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (P < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (P < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (P < 0.01) and a lower remission rate (P < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.

Original language	English
Pages (from-to)	399-409
Journal	European Journal of Endocrinology
Volume	178
Issue number	4
DOIs	https://doi.org/10.1530/EJE-17-0997
Publication status	Published - 1 Apr 2018

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Valassi, E., Franz, H., Brue, T., Feelders, R. A., Netea-Maier, R., Tsagarakis, S., Webb, S. M., Yaneva, M., Reincke, M., Droste, M., Komerdus, I., Maiter, D., Kastelan, D., Chanson, P., Pfeifer, M., Strasburger, C. J., Tóth, M., Chabre, O., Krsek, M., ... Zosin, I. (2018). Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN. European Journal of Endocrinology, 178(4), 399-409. https://doi.org/10.1530/EJE-17-0997

Valassi, Elena ; Franz, Holger ; Brue, Thierry ; Feelders, Richard A. ; Netea-Maier, Romana ; Tsagarakis, Stylianos ; Webb, Susan M. ; Yaneva, Maria ; Reincke, Martin ; Droste, Michael ; Komerdus, Irina ; Maiter, Dominique ; Kastelan, Darko ; Chanson, Philippe ; Pfeifer, Marija ; Strasburger, Christian J. ; Tóth, Miklós ; Chabre, Olivier ; Krsek, Michal ; Fajardo, Carmen ; Bolanowski, Marek ; Santos, Alicia ; Trainer, Peter J. ; Wass, John A.H. ; Tabarin, Antoine ; Ambrogio, A. ; Aranda, G. ; Arosio, M. ; Balomenaki, M. ; Beck-Peccoz, P. ; Berr-Kirmair, C. ; Bollerslev, J. ; Carvalho, D. ; Cavagnini, F. ; Christ, E. ; Denes, J. ; Dimopoulou, C. ; Dreval, A. ; Dusek, T. ; Erdinc, E. ; Evang, J. A. ; Fazel, J. ; Fica, S. ; Ghigo, E. ; Goth, M. ; Greenman, Y. ; Greisa, V. ; Halperin, I. ; Hanzu, F. A. ; Hermus, A. ; Johannsson, G. ; Kamenicky, P. ; Kasperlik-Zaluska, A. ; Kirchner, J. ; Kraljevic, I. ; Kruszynska, A. ; Lambrescu, I. ; Lang, S. ; Luger, A. ; Marpole, N. ; Martin, S. ; Martinie, M. ; Moros, O. ; Newell-Price, J. ; Orbetzova, M. ; Paiva, I. ; Pecori Giraldi, F. ; Pereira, A. M. ; Pickel, J. ; Pirags, V. ; Ragnarsson, O. ; Reghina, A. D. ; Riesgo, P. ; Roberts, M. ; Roerink, S. ; Roig, O. ; Rowan, C. ; Rudenko, P. ; Sahnoun, M. A. ; Salvador, J. ; Sigurjonsdottir, H. A. ; Skoric Polovina, T. ; Smith, R. ; Stachowska, B. ; Stalla, G. ; Toke, J. ; Ubina, E. ; Vinay, S. ; Wagenmakers, M. ; Werner, S. ; Young, J. ; Zdunowski, P. ; Zopf, K. ; Zopp, S. ; Zosin, I. / Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN. In: European Journal of Endocrinology. 2018 ; Vol. 178, No. 4. pp. 399-409.

@article{783d896fcac545c1b2ced3975e10680d,

title = "Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN",

abstract = "{\textcopyright} 2018 European Society of Endocrinology. Background: Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. Objective: (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). Patients and methods: 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS). Results: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (P < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (P < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (P < 0.01) and a lower remission rate (P < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.",

author = "Elena Valassi and Holger Franz and Thierry Brue and Feelders, {Richard A.} and Romana Netea-Maier and Stylianos Tsagarakis and Webb, {Susan M.} and Maria Yaneva and Martin Reincke and Michael Droste and Irina Komerdus and Dominique Maiter and Darko Kastelan and Philippe Chanson and Marija Pfeifer and Strasburger, {Christian J.} and Mikl{\'o}s T{\'o}th and Olivier Chabre and Michal Krsek and Carmen Fajardo and Marek Bolanowski and Alicia Santos and Trainer, {Peter J.} and Wass, {John A.H.} and Antoine Tabarin and A. Ambrogio and G. Aranda and M. Arosio and M. Balomenaki and P. Beck-Peccoz and C. Berr-Kirmair and J. Bollerslev and D. Carvalho and F. Cavagnini and E. Christ and J. Denes and C. Dimopoulou and A. Dreval and T. Dusek and E. Erdinc and Evang, {J. A.} and J. Fazel and S. Fica and E. Ghigo and M. Goth and Y. Greenman and V. Greisa and I. Halperin and Hanzu, {F. A.} and A. Hermus and G. Johannsson and P. Kamenicky and A. Kasperlik-Zaluska and J. Kirchner and I. Kraljevic and A. Kruszynska and I. Lambrescu and S. Lang and A. Luger and N. Marpole and S. Martin and M. Martinie and O. Moros and J. Newell-Price and M. Orbetzova and I. Paiva and {Pecori Giraldi}, F. and Pereira, {A. M.} and J. Pickel and V. Pirags and O. Ragnarsson and Reghina, {A. D.} and P. Riesgo and M. Roberts and S. Roerink and O. Roig and C. Rowan and P. Rudenko and Sahnoun, {M. A.} and J. Salvador and Sigurjonsdottir, {H. A.} and {Skoric Polovina}, T. and R. Smith and B. Stachowska and G. Stalla and J. Toke and E. Ubina and S. Vinay and M. Wagenmakers and S. Werner and J. Young and P. Zdunowski and K. Zopf and S. Zopp and I. Zosin",

year = "2018",

month = apr,

day = "1",

doi = "10.1530/EJE-17-0997",

language = "English",

volume = "178",

pages = "399--409",

journal = "European Journal of Endocrinology",

issn = "0804-4643",

publisher = "BioScientifica Ltd.",

number = "4",

}

Valassi, E, Franz, H, Brue, T, Feelders, RA, Netea-Maier, R, Tsagarakis, S, Webb, SM, Yaneva, M, Reincke, M, Droste, M, Komerdus, I, Maiter, D, Kastelan, D, Chanson, P, Pfeifer, M, Strasburger, CJ, Tóth, M, Chabre, O, Krsek, M, Fajardo, C, Bolanowski, M, Santos, A, Trainer, PJ, Wass, JAH, Tabarin, A, Ambrogio, A, Aranda, G, Arosio, M, Balomenaki, M, Beck-Peccoz, P, Berr-Kirmair, C, Bollerslev, J, Carvalho, D, Cavagnini, F, Christ, E, Denes, J, Dimopoulou, C, Dreval, A, Dusek, T, Erdinc, E, Evang, JA, Fazel, J, Fica, S, Ghigo, E, Goth, M, Greenman, Y, Greisa, V, Halperin, I, Hanzu, FA, Hermus, A, Johannsson, G, Kamenicky, P, Kasperlik-Zaluska, A, Kirchner, J, Kraljevic, I, Kruszynska, A, Lambrescu, I, Lang, S, Luger, A, Marpole, N, Martin, S, Martinie, M, Moros, O, Newell-Price, J, Orbetzova, M, Paiva, I, Pecori Giraldi, F, Pereira, AM, Pickel, J, Pirags, V, Ragnarsson, O, Reghina, AD, Riesgo, P, Roberts, M, Roerink, S, Roig, O, Rowan, C, Rudenko, P, Sahnoun, MA, Salvador, J, Sigurjonsdottir, HA, Skoric Polovina, T, Smith, R, Stachowska, B, Stalla, G, Toke, J, Ubina, E, Vinay, S, Wagenmakers, M, Werner, S, Young, J, Zdunowski, P, Zopf, K, Zopp, S & Zosin, I 2018, 'Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN', European Journal of Endocrinology, vol. 178, no. 4, pp. 399-409. https://doi.org/10.1530/EJE-17-0997

Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN. / Valassi, Elena; Franz, Holger; Brue, Thierry; Feelders, Richard A.; Netea-Maier, Romana; Tsagarakis, Stylianos; Webb, Susan M.; Yaneva, Maria; Reincke, Martin; Droste, Michael; Komerdus, Irina; Maiter, Dominique; Kastelan, Darko; Chanson, Philippe; Pfeifer, Marija; Strasburger, Christian J.; Tóth, Miklós; Chabre, Olivier; Krsek, Michal; Fajardo, Carmen; Bolanowski, Marek; Santos, Alicia; Trainer, Peter J.; Wass, John A.H.; Tabarin, Antoine; Ambrogio, A.; Aranda, G.; Arosio, M.; Balomenaki, M.; Beck-Peccoz, P.; Berr-Kirmair, C.; Bollerslev, J.; Carvalho, D.; Cavagnini, F.; Christ, E.; Denes, J.; Dimopoulou, C.; Dreval, A.; Dusek, T.; Erdinc, E.; Evang, J. A.; Fazel, J.; Fica, S.; Ghigo, E.; Goth, M.; Greenman, Y.; Greisa, V.; Halperin, I.; Hanzu, F. A.; Hermus, A.; Johannsson, G.; Kamenicky, P.; Kasperlik-Zaluska, A.; Kirchner, J.; Kraljevic, I.; Kruszynska, A.; Lambrescu, I.; Lang, S.; Luger, A.; Marpole, N.; Martin, S.; Martinie, M.; Moros, O.; Newell-Price, J.; Orbetzova, M.; Paiva, I.; Pecori Giraldi, F.; Pereira, A. M.; Pickel, J.; Pirags, V.; Ragnarsson, O.; Reghina, A. D.; Riesgo, P.; Roberts, M.; Roerink, S.; Roig, O.; Rowan, C.; Rudenko, P.; Sahnoun, M. A.; Salvador, J.; Sigurjonsdottir, H. A.; Skoric Polovina, T.; Smith, R.; Stachowska, B.; Stalla, G.; Toke, J.; Ubina, E.; Vinay, S.; Wagenmakers, M.; Werner, S.; Young, J.; Zdunowski, P.; Zopf, K.; Zopp, S.; Zosin, I.

In: European Journal of Endocrinology, Vol. 178, No. 4, 01.04.2018, p. 399-409.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Preoperative medical treatment in Cushing's syndrome: Frequency of use and its impact on postoperative assessment: Data from ERCUSYN

AU - Valassi, Elena

AU - Franz, Holger

AU - Brue, Thierry

AU - Feelders, Richard A.

AU - Netea-Maier, Romana

AU - Tsagarakis, Stylianos

AU - Webb, Susan M.

AU - Yaneva, Maria

AU - Reincke, Martin

AU - Droste, Michael

AU - Komerdus, Irina

AU - Maiter, Dominique

AU - Kastelan, Darko

AU - Chanson, Philippe

AU - Pfeifer, Marija

AU - Strasburger, Christian J.

AU - Tóth, Miklós

AU - Chabre, Olivier

AU - Krsek, Michal

AU - Fajardo, Carmen

AU - Bolanowski, Marek

AU - Santos, Alicia

AU - Trainer, Peter J.

AU - Wass, John A.H.

AU - Tabarin, Antoine

AU - Ambrogio, A.

AU - Aranda, G.

AU - Arosio, M.

AU - Balomenaki, M.

AU - Beck-Peccoz, P.

AU - Berr-Kirmair, C.

AU - Bollerslev, J.

AU - Carvalho, D.

AU - Cavagnini, F.

AU - Christ, E.

AU - Denes, J.

AU - Dimopoulou, C.

AU - Dreval, A.

AU - Dusek, T.

AU - Erdinc, E.

AU - Evang, J. A.

AU - Fazel, J.

AU - Fica, S.

AU - Ghigo, E.

AU - Goth, M.

AU - Greenman, Y.

AU - Greisa, V.

AU - Halperin, I.

AU - Hanzu, F. A.

AU - Hermus, A.

AU - Johannsson, G.

AU - Kamenicky, P.

AU - Kasperlik-Zaluska, A.

AU - Kirchner, J.

AU - Kraljevic, I.

AU - Kruszynska, A.

AU - Lambrescu, I.

AU - Lang, S.

AU - Luger, A.

AU - Marpole, N.

AU - Martin, S.

AU - Martinie, M.

AU - Moros, O.

AU - Newell-Price, J.

AU - Orbetzova, M.

AU - Paiva, I.

AU - Pecori Giraldi, F.

AU - Pereira, A. M.

AU - Pickel, J.

AU - Pirags, V.

AU - Ragnarsson, O.

AU - Reghina, A. D.

AU - Riesgo, P.

AU - Roberts, M.

AU - Roerink, S.

AU - Roig, O.

AU - Rowan, C.

AU - Rudenko, P.

AU - Sahnoun, M. A.

AU - Salvador, J.

AU - Sigurjonsdottir, H. A.

AU - Skoric Polovina, T.

AU - Smith, R.

AU - Stachowska, B.

AU - Stalla, G.

AU - Toke, J.

AU - Ubina, E.

AU - Vinay, S.

AU - Wagenmakers, M.

AU - Werner, S.

AU - Young, J.

AU - Zdunowski, P.

AU - Zopf, K.

AU - Zopp, S.

AU - Zosin, I.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - © 2018 European Society of Endocrinology. Background: Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. Objective: (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). Patients and methods: 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS). Results: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (P < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (P < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (P < 0.01) and a lower remission rate (P < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.

AB - © 2018 European Society of Endocrinology. Background: Surgery is the definitive treatment of Cushing's syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial. Objective: (1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS). Patients and methods: 1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS). Results: Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (P < 0.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (P < 0.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (P < 0.01) and a lower remission rate (P < 0.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups. Conclusions: PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.

U2 - 10.1530/EJE-17-0997

DO - 10.1530/EJE-17-0997

M3 - Article

VL - 178

SP - 399

EP - 409

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 0804-4643

IS - 4

ER -