In addition, patients with ectopic secretion of ACTH may be treated while expecting confirmation of the source, in the presence of metastatic cancer, or in patients who are not candidates for surgery for some reason.
Total suppression of cortisol excretion by ketoconazole in the therapy of the ectopic adrenocorticotropic hormone syndrome. Each patient had given informed consent allowing retrospective analyses of their medical records for scientific purposes, as approved by the ethics committees of each institution.
Retinoic acid RA has been studied in various types of tumor. Effect on the circadian profile of plasma ACTH and cortisol. Transsphenoidal surgery usually represents the first-line treatment of CD.
Letter to the Editor. UpToDate is the most trusted clinical decision support resource in the world. Journal of Endocrinological Investigation ; As ketoconazole is not currently approved in this indication in France, informed consent was obtained from each patient.
Sign In or Create an Account. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. In pituitary corticotroph tumors expressing EGFR, p 2 7 K i p 1a cyclin-dependent kinase inhibitor, is down regulated.
Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics
For example, although we asked each physician to assess whether clinical signs, glycemic control, hypertension, and hypokalemia had improved, worsened, or remained unchanged during the treatment, we were not able to quantitatively evaluate these modifications.
Is It Worth a Try? Different therapeutic efficacy of ketoconazole in patients with Cushing's syndrome. Ideally, management should be commenced in centers with appropriate experience and knowledge and involve a multidisciplinary team, including endocrinologists, neuroradiologists, dedicated neurosurgeons with expertise in pituitary tumor surgery or general surgeons in cases of ectopic tumorsnuclear medicine physicians and oncologists.
The mean age at diagnosis of CD was Ketoconazole has been used worldwide for more than 30 years in CD, but in the absence of a large-scale study, its efficacy and tolerance are still under debate.
Our study was not designed to define the benefits of such an approach, which might be of importance in patients with uncontrolled side effects of severe hypercortisolism. Infusion of low dose etomidate: Serum and salivary cortisol and plasma ACTH decreased, and clinical features of hypercortisolism diminished.
At high concentrations, it has been shown to be an antagonist of the glucocorticoid receptor in cultured hepatoma cells 21 and it binds to glucocorticoid receptors in cytosolic preparations of human mononuclear cells Total bilateral adrenalectomy induces a rapid resolution of the clinical features. We could not identify any other predictive factor of control of hypercortisolism, including initial UFC.
It has also been suggested that this drug may directly inhibit the pituitary corticotroph function, inhibiting ACTH secretion [ 11 — 13 ].
For each patient, the following data were recorded: The most appropriate management of ACTH-dependent CS derives from a multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists.