Discontinuation of Drug Treatment in Cushing's Disease Not Cured by Pituitary Surgery
Rattachement africain : fr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
OBJECTIVE: When transsphenoidal surgery (TSS) does not cure Cushing's disease (CD), 4 treatments are available: drug treatment (DT), second TSS (2nd TSS), bilateral adrenalectomy (BA), and pituitary radiotherapy (PR). DT is attractive but supposes long-term continuation, which we aimed to evaluate. DESIGN AND METHODS: Retrospective study, in a center prioritizing 2nd TSS, of 36 patients, including 19 with TSS failure and 17 with recurrence, out of 119 patients with CD treated by a first TSS, average follow-up 6.1 years (95% confidence interval 5.27-6.91). Control was defined as normalization of urinary free cortisol (UFC) and final treatment (FT) as the treatment allowing control at last follow-up. We also analyzed discontinuation rates of DT in published CD prospective clinical trials. RESULTS: Control was achieved in 33/36 patients (92%). DT was initiated in 29/36 patients (81%), allowing at least 1 normal UFC in 23/29 patients (79%) but was discontinued before last follow-up in 18/29 patients (62%). DT was FT in 11/29 patients (38%), all treated with cortisol synthesis inhibitors. Second TSS was FT in 8/16 (50%), BA in 14/14 (100%), and PR in 0/5. In published trials, discontinuation of DT was 11% to 51% at 1 year and 32% to 74% before 5 years. CONCLUSION: DT allowed at least 1 normal UFC in 23/29 patients (79%) but obtained long-term control in only 11/29 (38%), as discontinuation rate was high, although similar to published data. Interestingly, a successful 2nd TSS was the cause for discontinuing efficient and well-tolerated DT in 5 patients. Further studies will show whether different strategies with cortisol synthesis inhibitors may allow for a lower discontinuation rate in patients not candidates for a 2nd TSS so that BA may be avoided in these patients.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Discontinuation of Drug Treatment in Cushing's Disease Not Cured by Pituitary Surgery
- Date Crossref
- 14/11/2023
- Éditeur
- The Endocrine Society
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Centre Hospitalier Universitaire de Grenoble pays non établi dans la noticeÉtablissement de santé
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Université Grenoble Alpes pays non établi dans la noticeUniversité ou école supérieure
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Inserm pays non établi dans la noticeOrganisme public
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Commissariat à l'Énergie Atomique et aux Énergies Alternatives pays non établi dans la noticeOrganisme public
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CEA Grenoble pays non établi dans la noticeOrganisme public
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University Grenoble Alpes Department of Endocrinology CHU Grenoble Alpes pays non établi dans la noticeUniversité ou école supérieure
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National Institute of Engineering pays non établi dans la noticeStructure de recherche
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Unité Mixte de Recherche pays non établi dans la noticeInstitution
Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes et Inserm, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.