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. 2018 Apr;178(4):399-409.
doi: 10.1530/EJE-17-0997. Epub 2018 Feb 12.

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

Elena Valassi  1 , Holger Franz  2 , Thierry Brue  3   4 , Richard A Feelders  5 , Romana Netea-Maier  6 , Stylianos Tsagarakis  7 , Susan M Webb  8 , Maria Yaneva  9 , Martin Reincke  10 , Michael Droste  11 , Irina Komerdus  12 , Dominique Maiter  13 , Darko Kastelan  14 , Philippe Chanson  15   16   17 , Marija Pfeifer  18 , Christian J Strasburger  19 , Miklós Tóth  20 , Olivier Chabre  21 , Michal Krsek  22 , Carmen Fajardo  23 , Marek Bolanowski  24 , Alicia Santos  1 , Peter J Trainer  25 , John A H Wass  26 , Antoine Tabarin  27 ; ERCUSYN Study Group
Collaborators, Affiliations
Free article

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

Elena Valassi et al. Eur J Endocrinol. 2018 Apr.
Free article

Abstract

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.

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