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Background/purpose: Cushing's disease (CD) is the most common cause of endogenous Cushing's syndrome. Transsphenoidal surgery (TSS) is the first choice of treatment. Predicting prognosis after treatment can benefit further strategies of management, but currently there is no convenient predictor. This study aims to investigate characteristic changes after treatment and to identify potential prognostic predictors.Methods: We retrospectively studied the records of CD patients presenting to the National Taiwan University Hospital, Taipei, Taiwan between 1992 and 2011. They were categorized according to treatment response. Clinical features and examination findings were compared between groups.Results: Forty-one patients with CD were included. The follow-up time was 0.26-19.3 years. The time interval between the onset of symptoms and diagnosis was 2.1-120.0 months. The initial remission rate of CD after the first treatment was 82.9%. Mean body mass index (BMI) was 27.4 kg/m2 before treatment and 26.0 kg/m2 3 months after treatment. The patients in remission had a greater decrease in BMI after treatment and lower dehydroepiandrosterone sulfate (DHEAS) levels before treatment, compared with the recurrent group (both p < 0.05). Adrenocorticotropic hormone (ACTH) levels before treatment showed a significant positive correlation with recurrent diseases (p < 0.05).Conclusion: A larger decrease in BMI after treatment and lower DHEAS levels before treatment were noted for the patients who stayed in CD remission. Higher ACTH levels before treatment predicted a recurrence of CD. These are potentially simple and practical predictors of prognosis. [ABSTRACT FROM AUTHOR]

Background: Adrenalectomy represents the definitive treatment in clinically evident Cushing''s syndrome; however, the most appropriate treatment for patients with subclinical Cushing''s syndrome (SCS) with an adrenal incidentaloma remains controversial. This study was aimed to assess whether adrenalectomy may improve cardiovascular and metabolic impairment and quality of life compared with conservative management. Methods: Twenty patients with adrenal incidentaloma underwent laparoscopic adrenalectomy for SCS, whereas 15 were managed conservatively. Hormonal laboratory parameters of corticosteroid secretion, arterial blood pressure (BP), glycometabolic profile, and quality of life (by the SF-36 questionnaire) were compared at baseline and the end of follow-up. Results: The 2 groups were equivalent concerning all the examined parameters at baseline. In the operative group, laboratory corticosteroid parameters normalized in all patients but not in the conservative-management group (P < .001). In operated patients, a decrease in BP occurred in 53% of patients, glycometabolic control improved in 50%, and body mass index decreased; in contrast, no improvement or some worsening occurred in the conservative-management group (P < .01). SF-36 evaluation improved in the operative group (P < .05). Conclusion: Adrenalectomy can be more beneficial than conservative management in SCS and may achieve remission of laboratory hormonal abnormalities and improve BP, glycemic control, body mass index, and quality of life. [Copyright &y& Elsevier]

Copyright of Colombian Journal of Anesthesiology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Treatment of Cushing''s disease is often challenging. The success rates are not satisfactory and therapeutic interventions frequently causes hypopituitarism. We present three cases of remitting Cushing''s disease complicated with growth hormone deficiency. Surprisingly, growth hormone replacement resulted in complete clinical and laboratory remission of Cushing''s disease in these patients. However, one of the patients died of myocardial infarction. Effects of growth hormone on cortisol metabolism are discussed. [Copyright &y& Elsevier]

The article presents a study which examines the endocrinological status and serum chemistry of dogs with Cushing's disease after undergoing transsphenoidal surgery (TSS). Researchers analyzed 25 dogs suffering from Cushing's disease over an 8-year period that were subjected to TSS. After undergoing TSS, the adrenocorticotropic hormone (ACTH) stimulation tests manifested low serum cortisol concentrations in 21 dogs. Researchers also concluded that the surgical treatment is effective for dogs' Cushing's disease and for hypercortisolemia.

Background: We reviewed our experience with micronodular adrenal hyperplasia (MAH), its pigmented variant primary pigmented nodular adrenocortical disease (PPNAD), and the association with Carney''s complex (CNC) to better characterize these disorders. Methods: This retrospective study analyzes clinical data and operative reports of 34 patients identified with MAH and/or PPNAD who underwent resection between 1969 and 2006 at the Clinical Research Center, an inpatient research hospital at the National Institutes of Health. Symptoms and anthropometric and biochemical data were used to evaluate effect of resection. Results: Fifteen patients (44%) presented as adults and 19 (56%) as children. Twenty-five patients (74%) presented with noncyclic Cushing syndrome and 9 patients (26%) presented with cyclic Cushing syndrome. Thirty-one patients underwent bilateral resection; this was curative biochemically in 30 patients. Fourteen operations were performed laparoscopically (41%), and 20 were performed as open resections (59%). There was 1 postoperative complication in the laparoscopic group (7%) and 6 complications in the open group (30%; P = .20). Follow-up was available for 25 patients (74%). Statistically significant improvements in anthropometrics were observed for both adults and children. The most frequent manifestation of CNC requiring additional operation was cardiac myxoma, which was associated strongly with an atypical (cyclic) presentation of Cushing syndrome (P = .009). Conclusion: Cushing syndrome due to MAH and PPNAD may be cured by bilateral adrenal resection. All patients should be screened for manifestations of CNC at the time of adrenal diagnosis with particular attention to cardiac disease. [Copyright &y& Elsevier]

Copyright of Revista da Faculdade de Odontologia is the property of UFRGS-Faculdade de Odontologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: It is hypothesized that blocking the adrenocorticotrophic hormone (ACTH) receptor, using either a blocking antibody or a drug will result in a medical cortical-adrenalectomy, with relative sparing of mineralocorticoid hormone production. This would be similar to the clinical findings in familial glucocorticoid deficiency type 1, an autosomal recessive condition due to inactivating mutations of the adrenal receptor for ACTH, also known as the melanocortin 2 receptor (MC2R). It is further hypothesized that MC2R blockade should allow using lower glucocorticoid doses to treat congenital adrenal hyperplasia (CAH) due to enzyme deficiency of either 21-hydroxylase (CYP21B) or 11-hydroxylase (CYP11B1), thus reaching a better final adult height than with current therapeutic strategies. Blocking the ACTH receptor can also be employed to medically treat Cushing’s due to excess pituitary or ectopic ACTH production. [Copyright &y& Elsevier]

Cushing's disease results from prolonged overexposure of tissues to endogenous glucocorticoids, secondary to adrenocorticotrophin excess from the pituitary. Common clinical signs and symptoms include weight gain, hypertension, and osteoporosis. Effective treatment of Cushing''s disease can normalize biochemical levels, reverse comorbidities, and improve overall survival and quality of life. Treatment options include pituitary or adrenal surgery, radiotherapy, and various medical therapies, but each has important limitations. Medical therapies that effectively target the pituitary tumour are urgently needed. [Copyright &y& Elsevier]