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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
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An individualized approach to the management of Cushing disease
Maria Fleseriu1,2,3, Elena V Varlamov4, Jose M Hinojosa-Amaya5
1Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, OR, USA. fleseriu@ohsu.edu.
Nature Reviews. Endocrinology
|August 3, 2023
Summary
Cushing disease, driven by ACTH-secreting pituitary tumors, presents diagnostic and management challenges. Early diagnosis and tailored treatment are crucial for improving patient outcomes and reducing mortality.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Cushing disease results from ACTH-secreting pituitary adenomas, causing hypercortisolaemia and significant mortality.
- Diagnosis is complex due to heterogeneous symptoms and biochemical testing limitations.
- Pituitary adenomas are often small and may not be detected by MRI.
Purpose of the Study:
- To review the challenges in diagnosing and managing Cushing disease in adults.
- To provide guidance for an integrated and individualized patient management approach.
Main Methods:
- Review of diagnostic tests including salivary cortisol, urinary free cortisol, and dexamethasone suppression tests.
- Discussion of imaging modalities like MRI and the gold standard, inferior petrosal sinus sampling.
- Overview of treatment options: transsphenoidal surgery, medical therapy, pituitary radiation, and bilateral adrenalectomy.
Main Results:
- Inferior petrosal sinus sampling is the gold standard for confirming pituitary ACTH secretion.
- Transsphenoidal adenoma resection is the primary treatment, with medical therapy used preoperatively in some regions.
- Management requires addressing persistent or recurrent disease with medication, radiation, or adrenalectomy.
Conclusions:
- Lifelong surveillance is essential for comorbidities, recurrence, and treatment side effects.
- An integrated and individualized approach is necessary for effective Cushing disease management.
- Addressing diagnostic and therapeutic challenges is key to improving patient survival and quality of life.
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