Session: OR02-Diagnosing and Treating Cortisol Excess and Deficiency
W190 (McCormick Place West Building)
Objective: 1) To study the prevalence of PMT in CS patients throughout Europe; and 2) To evaluate any differences in surgical outcome between patients who received PMT vs. those who did not.
Methods/Design: In October 2013 ERCUSYN included 1023 patients (821 F, 202 M; mean age (+SD) 44.7±13.5 years) from 57 centers in 28 countries. It comprises 669 (65%) pituitary-dependent CS (PIT-CS), 249 (24%) adrenal-dependent CS (ADR-CS), and 105 (11%) from other etiologies, including ectopic (ECT-CS).
Results: Two hundred and twenty-eight CS patients of 930 (25%) with therapy data available took PMT vs. 634 who did not (68%). A subset of 65/930 (7%) was excluded from analysis because only medical treatment was given, but no subsequent surgery. More than half of CS patients who were medically treated before surgery were from the Netherlands, France and Spain. Patients with PIT-CS received PMT more frequently than the other etiologic groups (82% PIT-CS vs. 7% ADR-CS and 10% ECT-CS; p<0.01 for both comparisons). KTZ was the most commonly used medication, given to 171 of 228 patients (75%; alone or in combination) vs. MTP administered to 53 (23%), CAB to 18 (8%), and mifepristone to 10 (4%) patients. Mitotane and aminogluthetimide were taken by 2 and 1 patients, with PIT-CS. Median duration of PMT was 103 days (range:1-1155 days). Median cumulative dose of KTZ and MTP was 66 gr (range:1,6-1314gr) and 120gr, (range: 6-1838.5gr), respectively. Median cumulative dose of CAB was 0.06 gr (range: 0.015-8.6 gr). Of 471 PIT-CS patients in remission in the immediate postoperative period (within 2 weeks since surgery), 326 (69%) had not received any PMT vs. 144 (31%) who had been medically treated (p<0.01). Early hypoadrenalism was reported in significantly more patients without PMT (70%), as compared with those who had taken PMT (30%) (p<0.01). After a median follow-up of 975 days (range:181-8153 days), 319 PIT-CS were in remission, of whom 196 (61%) had not taken PMT vs. 123 (38%) who had been medically treated before surgery (p<0.01).
- PMT may be associated with lower prevalence of postoperative hypoadrenalism in PT-CS patients; this may be due to decreased negative feedback, leading to recovery of pituitary-adrenal axis function.
- PMT appears to be associated with lower prevalence of long-term remission in PIT-CS patients, although this may be determined by a more severe initial clinical presentation.
Disclosure: TB: Clinical Researcher, Pfizer, Inc., Clinical Researcher, Novo Nordisk, Clinical Researcher, Novartis Pharmaceuticals, Clinical Researcher, Ipsen, Clinical Researcher, Serono, Clinical Researcher, Sandoz. CJS: Advisory Group Member, Chiasma. PJT: Principal Investigator, HRA Pharma. Nothing to Disclose: EV, AS, RTN, RAF, JAW, PC, MY, ST, KZ, OC, IVK, MT, HF, SWJL, SMW
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