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Aftercare in patients with Cushing’s disease and acromegaly: is there room for improvement?

  • Clinical Article
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Abstract

Purpose

Evaluation of aftercare, medical therapy and remission rate for Cushing′s disease (CD) and acromegaly (AC).

Methods

Fifty-eight CD and 83 AC patients operated on over 10 years were carefully evaluated. The patients received a disease-related questionnaire and were invited for a follow-up at the outpatient clinic of the Department of Neurosurgery. Thirty-three CD and 52 AC patients returned the questionnaire; 25 CD and 37 AC patients participated personally. CD patients underwent a dexamethasone suppression test, and IGF-1 levels were assessed in AC patients. Data on postoperative therapy were assessed.

Results

84.8% of those with CD and 75.0% of those with AC had been followed by endocrinologists; 9.1% of CD and 1.9% of AC patients had been under no aftercare; 96% of CD patients were in remission. A recurrence occurred in four patients, two were newly detected by our study. IGF-1 was postoperatively normalized in 25 of 37 AC patients (67.6%). Twenty patients remained in remission, five relapsed. One patient received medical therapy upon recurrence and presented normal IGF-1; four patients with relapse had not been treated yet. Ten of 12 patients with elevated early postoperative IGF-1 received medical therapy that was commenced within 6 months in nine cases. The mean duration of medical therapy was 36 months (range 2–92). IGF-1 was still elevated at the last follow-up in eight of these ten patients, all of them receiving monotherapy. In four patients, the dose had been increased once.

Conclusions

The postoperative transfer back to the endocrinologist after operative treatment is achieved well in both groups. In uncured AC, medical therapy is initiated early, but options of therapy offer room for improvement. Therapy of recurrence is delayed in both pathologies.

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References

  1. Abs R, Verhelst J, Maiter D, Van Acker K, Nobels F, Coolens JL, Mahler C, Beckers A (1998) Cabergoline in the treatment of acromegaly: a study in 64 patients. J Clin Endocrinol Metab 83:374–378

    Article  CAS  PubMed  Google Scholar 

  2. Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, Fava GA, Findling JW, Gaillard RC, Grossmann AB, Kola B, Lacroix A, Mancini T, Mantero F, Newell-Price J, Nieman LK, Sonino N, Vance ML, Giustina A, Boscaro M (2003) Diagnosis and complications of Cushing′s syndrome: a consensus statement. J Clin Endocrinol Metab 88:5593–5602

    Article  CAS  PubMed  Google Scholar 

  3. Ayuk J, Clayton RN, Holder G, Sheppard MC, Stewart PM, Bates AS (2004) Growth hormone and pituitary radiotherapy, but not serum insulin-like growth factor-I concentration, predict excess mortality in patients with acromegaly. J Clin Endocrinol Metab 89:1613–1617

    Article  CAS  PubMed  Google Scholar 

  4. Bex M, Abs R, T′Sjoen G, Mockel J, Velekniers B, Muermans K, Maiter D (2007) AcroBel- the Belgian registry on acromegaly: a survey of the ‘real-life’ outcome in 418 acromegalic subjects. J Clin Endocrinol Metab 157:399–409

    CAS  Google Scholar 

  5. Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A, Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M (2008) Treatment of adrenocorticotropin-dependent Cushing′s syndrome: a consensus statement. J Clin Endocrinol Metab 93:2454–2462

    Article  CAS  PubMed  Google Scholar 

  6. Bochicchio D, Losa M, Buchfelder M (1995) Factors influencing the immediate and late outcome of Cushing′s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing′s disease survey group. J Clin Endocrinol Metab 80:3114–3120

    Article  CAS  PubMed  Google Scholar 

  7. Bogazzi F, Battolla L, Spinelli C, Rossi G, Gavioli S, Di Bello V, Cosci C, Sardella C, Volterrani D, Talini E, Pepe P, Falschi F, Mariani G, Martino E (2007) Risk factors for development of coronary heart disease in patients with acromegaly: a five-year prospective study. J Clin Endocrinol Metab 92:4271–4277

    Article  CAS  PubMed  Google Scholar 

  8. Boscaro M, Barzon L, Fallo F, Sonino N (2001) Cushing′s syndrome. Lancet 357:783–791

    Article  CAS  PubMed  Google Scholar 

  9. Cavagnini F, Pecori Giraldi F (2001) Epidemiology and follow-up of Cushing′s disease. Ann Endocrinol (Paris) 62:168–172

    CAS  Google Scholar 

  10. Coculescu M, Niculescu D, Lichiardopol R, Pureci M (2007) Insulin resistance and insulin secretion in non-diabetic acromegalic patients. J Clin Endocrinol Metab 115:308–316

    CAS  Google Scholar 

  11. Colao A, Ferone D, Marzullo P, Cappabianca P, Cirillo S, Boerlin V, Lancranjan I, Lombardi G (2001) Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab 86:2779–2786

    Article  CAS  PubMed  Google Scholar 

  12. Colao A, Pivonello R, Spiezia S, Faggiano A, Ferone D, Filipella M, Marzullo P, Cerbone G, Siciliani M, Lombardi G (1999) Persistence of increased cardiovascular risk in patients with Cushing′s disease after five years of successful cure. J Clin Endocrinol Metab 84:2664–2672

    Article  CAS  PubMed  Google Scholar 

  13. Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirova MA, Beckers A (2006) High prevalence of pituitary adenomas: a cross-sectional study in the province of Liège, Belgium. J Clin Endocrinol Metab 91:4769–4775

    Article  CAS  PubMed  Google Scholar 

  14. Elamin MB, Murad H, Mullan R, Erickson D, Harris K, Nadeem S, Ennis R, Erwin PJ, Montori VM (2008) Accuracy of diagnostic tests for Cushing′s syndrome: a systematic review and metaanalyses. J Clin Endocrinol Metab 93:1553–1562

    Article  CAS  PubMed  Google Scholar 

  15. Etxabe J, Vazquez JA (1994) Morbidity and mortality in Cushing′s disease: an epidemiological approach. Clin Endocrinol 40:479–484

    Article  CAS  Google Scholar 

  16. Findling JW, Raff H (2006) Cushing′s syndrome: important issues in diagnosis and management. J Clin Endocrinol Metab 91:3746–3753

    Article  CAS  PubMed  Google Scholar 

  17. Freda PU, Katznelson L, van der Lely AJ, Reyes CM, Zhao S, Rabinowitz D (2005) Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 90:4465–4473

    Article  CAS  PubMed  Google Scholar 

  18. Holdaway IM, Rajasoorya RC, Gamble GD (2004) Factors influencing mortality in acromegaly. J Clin Endocrinol Metab 89:667–674

    Article  CAS  PubMed  Google Scholar 

  19. Kauppinen-Mäkelin R, Sane T, Reunanen A, Välimäki NJ, Niskanen L, Markkanen H, Löyttyeniemi E, Ebeling T, Jaatinen P, Laine H, Nuutila P, Salmela P, Salmi J, Stenman UH, Viikari J, Voutilainen E (2005) A nationwide survey of mortality in acromegaly. J Clin Endocrinol Metab 90:4081–4086

    Article  PubMed  Google Scholar 

  20. Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A (2009) Acromegaly consensus group guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94:1509–1517

    Article  CAS  PubMed  Google Scholar 

  21. Mestrón A, Webb SM, Astorga R, Benito P, Catala M, Gatzambide S, Gomez JM, Halperin I, Lucas-Morante T, Moreno B, Obiols G, de Pablos P, Paramo C, Pico A, Torres E, Varela C, Vasquez JA, Zamora J, Albareda M, Gilabert M, on behalf of all the REA participants (2004) Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Español de Acromegalia, REA). Eur J Endocrinol 151:439–446

    Article  PubMed  Google Scholar 

  22. Nachtigall L, Delgado A, Swearingen B, Lee H, Zerikly R, Klibanski A (2008) Extensive clinical experience: changing patterns in diagnosis and therapy of acromegaly over two decades. J Clin Endocrinol Metab 93:2035–2041

    Article  CAS  PubMed  Google Scholar 

  23. Newman CB, Melmed S, George A, Torigian D, Duhaney M, Snyder P, Young W, Klibanski A, Molitch ME, Gagel R, Sheeler L, Cook D, Malarkey W, Jackson I, Vance ML, Barkan A, Frohman L, Kleinberg DL (1998) Octreotide as primary therapy in acromegaly. J Clin Endocrinol Metab 3:3034–3040

    Article  Google Scholar 

  24. Pereira AM, van Thiel SW, Lindner JR, Roelfsema F, van der Wall EE, Morreau H, Smit JW, Romijn JA, Bax JJ (2004) Increased prevalence of regurgitant valvular heart disease in acromegaly. J Clin Endocrinol Metab 89:71–75

    Article  CAS  PubMed  Google Scholar 

  25. Plotz CM, Knowlton AL, Ragan C (1952) The natural history of Cushing′s Syndrome. Am J Med 13:597–614

    Article  CAS  PubMed  Google Scholar 

  26. Ross EJ, Linch DC (1982) Cushing′s syndrome-killing disease: discriminatory value of signs and symptoms aiding early diagnosis. Lancet 2:646–649

    Article  CAS  PubMed  Google Scholar 

  27. Swearingen B, Barker FG, Katznelson L, Biller BMK, Grinspoon S, Klibanski A, Moayeri N, Black P, Zervas NT (1998) Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 10:3419–3426

    Article  Google Scholar 

  28. Swearingen B, Biller BMK, Barker FG II, Katznelson L, Grinspoon S, Klibanski A, Zervas N (1999) Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 130:821–824

    CAS  PubMed  Google Scholar 

  29. van der Lely AJ, Hutson RK, Trainer PJ, Besser GM, Barkan AL, Katznelson L, Klibanski A, Herman-Bonert V, Melmed S, Vance ML, Freda PU, Stewart PM, Friend KE, Clemmons DR, Johannsson G, Stavrou S, Cook DM, Phillips LS, Strasburger CJ, Hackett S, Zib KA, Davis RJ, Scarlett JA, Thorner MO (2001) Long-term treatment of acromegaly with pegvisomant, a growth hormone-receptor antagonist. Lancet 358:1754–1759

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was sponsored by an unrestricted grant from Novartis Oncology.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany

    Tsambika Psaras, Monika Milian, Valerie Hattermann & Juergen Honegger

  2. Department of Endocrinology, University of Tuebingen, Tuebingen, Germany

    Baptist Gallwitz

  3. Department of Neurosurgery, University of Freiburg, Freiburg, Germany

    Thomas Freiman

Authors
  1. Tsambika Psaras
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  2. Monika Milian
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  3. Valerie Hattermann
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  4. Baptist Gallwitz
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  6. Juergen Honegger
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Correspondence to Tsambika Psaras.

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Psaras, T., Milian, M., Hattermann, V. et al. Aftercare in patients with Cushing’s disease and acromegaly: is there room for improvement?. Acta Neurochir 152, 271–278 (2010). https://doi.org/10.1007/s00701-009-0544-6

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  • DOI: https://doi.org/10.1007/s00701-009-0544-6

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