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Cited by 99Pituitary Gland Disorders and TreatmentsAdrenal Hormones and DisordersAdrenal and Paraganglionic Tumors

Time to recovery of adrenal function after curative surgery for Cushing’s syndrome depends on etiology

Berr, Christina M., Di Dalmazi, Guido, Osswald, Andrea, Ritzel, Katrin, Bidlingmaier, Martin, Geyer, Lucas L., Treitl, Marcus, Hallfeldt, Klaus +6 more·2015·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2014-3632
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Abstract

CONTEXT: Successful tumor resection in endogenous Cushing's syndrome (CS) results in tertiary adrenal insufficiency requiring hydrocortisone replacement therapy. OBJECTIVE: The aim was to analyze the postsurgical duration of adrenal insufficiency of patients with Cushing's disease (CD), adrenal CS, and ectopic CS. DESIGN: We performed a retrospective analysis based on the case records of 230 patients with CS in our tertiary referral center treated from 1983-2014. The mean follow-up time was 8 years. PATIENTS: We included 91 patients of the three subtypes of CS undergoing curative intended surgery and documented followup after excluding cases with persistent disease, pituitary radiation, concurrent adrenostatic or somatostatin analog treatment, and malignant adrenal disease. RESULTS: The probability of recovering adrenal function within a 5 years followup differed significantly between subtypes (P = .001). It was 82% in ectopic CS, 58% in CD and 38% in adrenal CS. In the total cohort with restored adrenal function (n = 52) the median time to recovery differed between subtypes: 0.6 years (interquartile range [IQR], 0.03-1.1 y) in ectopic CS, 1.4 years (IQR, 0.9-3.4 y) in CD, and 2.5 years (IQR, 1.6-5.4 y) in adrenal CS (P = .002). In CD the Cox proportional-hazards model showed that the probability of recovery was associated with younger age (hazard ratio, 0.896; 95% confidence interval, 0.822-0.976; P = .012), independently of sex, body mass index, duration of symptoms, and basal ACTH and cortisol levels. There was no correlation with length and extend of hypercortisolism or postoperative glucocorticoid replacement doses. CONCLUSIONS: Time to recovery of adrenal function is dependent on the underlying etiology of CS.

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  • Even though treatment regimens, route of administration, potency, dose, duration of glucocorticoid treatment, as well as individual glucocorticoid sensitivity, have been postulated as potential risk factors for glucocorticoid-induced AI, no clear-cut predictive factors of risk of onset and duration of AI before HPA axis recovery have been identified so far.

    “Even though treatment regimens, route of administration, potency, dose, duration of glucocorticoid treatment, as well as individual glucocorticoid sensitivity, have been postulated as potential risk factors for glucocorticoid-induced AI, no clear-cut predictive factors of risk of onset and duration of AI before HPA axis recovery have been identified so far (15, 16, 20, 21).”

    From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [20]

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Authors
Berr, C. M., Di Dalmazi, G., Osswald, A., Ritzel, K., Bidlingmaier, M., Geyer, L. L., Treitl, M., Hallfeldt, K., Rachinger, W., Reisch, N., Blaser, R., Schopohl, J., Beuschlein, F., & Reincke, M.
Affiliations
  • LMU Klinikum (DE)
  • TUM Klinikum (DE)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2015-04
Volume
100
Issue
4
Pages
1300-1308
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2014-3632
OpenAlex
W2138623456
Cited by
99
References
29
Citations by year
2026: 10 · 2025: 12 · 2024: 6 · 2023: 9 · 2022: 9 · 2021: 13 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 6 · 2016: 9 · 2015: 3
FWCI
4.83
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
Keywords
Cushing's syndrome, Cushing's disease, adrenal Cushing's syndrome, ectopic ACTH syndrome, adrenal insufficiency, adrenalectomy, hydrocortisone replacement, tumor resection, age as predictor
MeSH terms
Adenoma, Adrenal Insufficiency, Adrenal Glands, Adult, Cushing Syndrome, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Retrospective Studies, Time Factors, Recovery of Function, ACTH-Secreting Pituitary Adenoma

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