The impact of surgical management of Cushing's disease in pregnancy on foetal outcomes

PurposeDyslipidemia has been frequently reported and associated with increased cardiovascular risk in patients with Cushing’s disease (CD). Few studies are available regarding the relationships between lipid abnormalities and other preoperative metabolic comorbidities in CD, and the data on alterations of the lipid profile after surgery is quite variable. We aimed to investigate the associations between hyperlipidemia and other baseline metabolic and hormonal parameters and the impact of surgical remission on lipid metabolism in patients with CD.MethodsThis retrospective study included 104 patients diagnosed with CD. Baseline hormonal and metabolic parameters were compared between the hyperlipidemia (HLP) group and non-hyperlipidemia (NLP) group, and their relationships with hyperlipidemia at diagnosis were evaluated. Alterations in lipid profiles after surgical remission of CD were evaluated in 65 patients with available follow-up data.ResultsUpon baseline, logistic regression analysis showed that impaired glucose metabolism (IGM) (OR=4.68, 95%CI:1.38–15.91) and morning cortisol levels (per 10 μg/dl change) (OR=1.81, 95%CI:1.11–2.95) are both independent risk factors of preoperative occurrence of hyperlipidemia in patients with CD. The baseline triglyceride (TG) level was positively correlated with systolic blood pressure (SBP) (r=0.297, p=0.003). Lipid abnormalities had improvement but may persist after surgical remission, and the persisted hyperlipidemia is associated with higher baseline total cholesterol (TC) levels (r=0.505, p=0.033).ConclusionsPersistence of post-surgery hyperlipidemia is associated with severe baseline lipid abnormalities. Surgical remission with concomitant control of impaired glucose metabolism at diagnosis may have significant implications for controlling hyperlipidemia and reducing cardiovascular risk in CD.

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The impact of the Cushing's Disease remission in associated comorbidities

Endocrine Abstracts ◽

10.1530/endoabs.35.p943 ◽

2014 ◽

Author(s):

Vera Fernandes ◽

Maria J Santos ◽

Rui Almeida ◽

Olinda Marques

Keyword(s):

Cushing’S Disease ◽

Cushing's Disease ◽

Disease Remission ◽

The Impact

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Recurrence of Cushing's disease in pregnancy. Case report

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.1985.tb01098.x ◽

1985 ◽

Vol 92 (3) ◽

pp. 295-298 ◽

Cited By ~ 12

Author(s):

C. G. SEMPLE. H. McEWAN ◽

G. M. TEASDALE ◽

A. M. McNICOL ◽

J. A. THOMSON

Keyword(s):

Case Report ◽

Cushing’S Disease ◽

Cushing's Disease ◽

In Pregnancy

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Doubled mortality rate in irradiated patients reoperated for regrowth of a macroadenoma of the pituitary gland

Acta Endocrinologica ◽

10.1530/eje.0.1500497 ◽

2004 ◽

pp. 497-502 ◽

Cited By ~ 15

Author(s):

EM Erfurth ◽

B Bulow ◽

CH Nordstrom ◽

Z Mikoczy ◽

L Hagmar ◽

...

Keyword(s):

Mortality Rate ◽

Life Expectancy ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Cox Regression ◽

Cushing's Disease ◽

Calendar Time ◽

Cox Regression Analysis ◽

Risk Increase ◽

The Impact

BACKGROUND: Reduced life expectancy has been shown in patients with hypopituitarism, mainly caused by cardiovascular diseases. A major cause of hypopituitarism is pituitary adenomas, and radiotherapy may be employed as a treatment modality to reduce the post-operative regrowth rate of these tumours. Recently, we showed that in patients with craniopharyngiomas, tumour regrowth foreshadowed a fourfold risk increase for death. For patients with pituitary adenomas, the impact of regrowth on life expectancy is, however, not known. OBJECTIVE: To assess the impact of a reoperation due to a regrowth of a pituitary macroadenoma on mortality, taking into account other candidate prognostic factors. DESIGN AND PATIENTS: In 281 patients with operated and irradiated macroadenomas, excluding acromegaly and Cushing's disease, 35 patients had a regrowth (median follow-up 16.6 years). Possible risk factors for tumour regrowth were investigated by Cox regression models. RESULTS: For tumour regrowth, age, calendar time at primary surgery, gender and extension of tumour growth had no statistically significant impact. For younger patients, the proportion of regrowths was higher, but after age-stratified Cox regression analysis only regrowth was shown to have a significant impact on mortality, with a more than doubled mortality risk for patients with tumour regrowth as compared with the non-regrowing tumour patients (hazard ratio=2.24, P<0.001). This finding was corroborated by cohort analyses using the general population as an external comparison group. CONCLUSION: Among patients with irradiated pituitary macroadenomas, excluding acromegaly and Cushing's disease, a doubled mortality rate was observed for those reoperated for tumour regrowth as compared with patients with non-regrowing tumours.

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Surgical management of pediatric Cushing's disease

Surgical Neurology ◽

10.1016/j.surneu.2006.05.067 ◽

2007 ◽

Vol 67 (3) ◽

pp. 251-257 ◽

Cited By ~ 9

Author(s):

N. Kumar Das ◽

Bernard T. Lyngdoh ◽

B. Kiran Bhakri ◽

Sanjay Behari ◽

Vijaylakshmi Bhatia ◽

...

Keyword(s):

Surgical Management ◽

Cushing’S Disease ◽

Cushing's Disease

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A Case of Cushing's Disease in Pregnancy

Endocrinology and Metabolism ◽

10.3803/enm.2011.26.4.348 ◽

2011 ◽

Vol 26 (4) ◽

pp. 348

Author(s):

Jeong Tae Kim ◽

Mun Hyuk Sung ◽

Woo Ri Park ◽

Jeong Ho Han ◽

Hye Suk Han ◽

...

Keyword(s):

Cushing’S Disease ◽

Cushing's Disease ◽

In Pregnancy

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GEOFFREY HARRIS AWARD 2019: Translational research in pituitary tumours

Acta Endocrinologica ◽

10.1530/eje-19-0677 ◽

2020 ◽

Vol 182 (1) ◽

pp. R1-R13 ◽

Cited By ~ 1

Author(s):

Günter K Stalla ◽

Christina Dimopoulou ◽

Caroline Jung-Sievers ◽

Eduardo Arzt ◽

Marcelo Paez Pereda ◽

...

Keyword(s):

Drug Resistance ◽

Cushing’S Disease ◽

Additional Treatment ◽

Cushing's Disease ◽

Considerable Proportion ◽

Somatostatin Analogue ◽

Incomplete Resection ◽

Pituitary Tumours ◽

Treatment Concepts ◽

The Impact

Although effective treatment regimens (surgical resection, drug treatment with dopamine agonists or somatostatin analogues, radiotherapy) have been established for the therapy of most pituitary tumours, a considerable proportion of affected patients cannot completely cured due to incomplete resection or drug resistance. Moreover, even if hormone levels have been normalized, patients with hormone-secreting tumours still show persistent pathophysiological alterations in metabolic, cardiovascular or neuropsychiatric parameters and have an impaired quality of life. In this review reasons for the discrepancy between biochemical cure and incomplete recovery from tumour-associated comorbidities are discussed and the clinical management is delineated exemplarily for patients with acromegaly and Cushing’s disease. In view of the development of additional treatment concepts for the treatment of pituitary adenomas we speculate about the relevance of RSUME as a potential target for the development of an anti-angiogenic therapy. Moreover, the role of BMP-4 which stimulates prolactinoma development through the Smad signalling cascade is described and its role as putative drug target for the treatment of prolactinomas is discussed. Regarding the well-known resistance of a part of somatotropinomas to somatostatin analogue treatment, recently identified mechanisms responsible for the drug resistance are summarized and ways to overcome them in future treatment concepts are presented. Concerning novel therapeutic options for patients with Cushing’s disease the impact of retinoic acid, which is currently tested in clinical studies, is shown, and the action and putative therapeutic impact of silibinin to resolve glucocorticoid resistance in these patients is critically discussed.

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