TITLE

ACTH-secreting macroadenoma: Experience from a single tertiary care center in India

AUTHOR(S)
Kakade, Harshal
PUB. DATE
September 2013
SOURCE
Indian Journal of Endocrinology & Metabolism;2013 Supplement, Vol. 17 Issue S1, pS394
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To study clinical profile and treatment outcome of patient of Cushing disease with macroadenoma to a single tertiary care center in India. Patients and Methods: Medical records of 42 patients diagnosed with Cushing macroadenoma from 1993 to 2012 were reviewed. Results: Out of 42 patients, 16 were male and 24 were female. Mean age of presentation was 27.6 ± 10.67 years. Median duration between onset of symptoms and diagnosis was 24 months. Median ACTH value was 97.1 pg/mL. Visual field defects and mass effect were found in 15 patients. Mean maximum dimension of tumor was 20.7 ± 9.8 mm. All 42 patients underwent TSS . Six patients underwent early remission and eleven patients showed (first TSS: cure rate: 37%) delayed remission. Among 25 uncured patients and 4 relapses, 8 lost to follow-up and 2 died. Nineteen underwent second line of management-seven: second TSS, two: medical management and ten: radiotherapy. Cure rate of second TSS was 12.5% and radiotherapy was 71%. Conclusion: Largest series of Cushing macroadenoma. Compared to literature, we have large proportion of macroadenoma, young macros (<30 years: 60%), and larger tumor size. The peculiar feature is delayed cure 65% of cured patients. Results of second TSS were poor and radiotherapy is very effective mode of therapy.
ACCESSION #
91656688

 

Related Articles

  • Childhood Cushing Disease: A Challenge in Diagnosis and Management. Shah, Nalini S.; Lila, Anurag // Hormone Research in Paediatrics;Jul2011 Supplement, Vol. 76 Issue S1, p65 

    Background: Cushing syndrome (CS) in childhood is an extremely rare disorder that poses unique diagnostic difficulties. Different etiopathological states account for endogenous hypercortisolism in various age groups. Diagnosis is especially challenging in individuals with adrenocorticotropic...

  • Role of Somatostatin Receptors in Normal and Tumoral Pituitary Corticotropic Cells. Hofland, Leo J.; Lamberts, Steven W.J.; Feelders, Richard A. // Neuroendocrinology;Sep2010 Supplement, Vol. 92, p11 

    Normal and tumoral pituitary corticotropic cells express sst2 and sst5, of which sst5 is the predominantly expressed receptor subtype. Somatostatin (SS) inhibits pituitary adrenocorticotropin hormone (ACTH) secretion in vitro, but the sensitivity to SS is strongly regulated by glucocorticoids....

  • Medical Treatment of Cushing’s Disease: Somatostatin Analogues and Pasireotide. Pedroncelli, Alberto M. // Neuroendocrinology;Sep2010 Supplement, Vol. 92, p120 

    Cushing’s disease is Cushing’s syndrome caused by an adrenocorticotropic hormone-secreting pituitary adenoma and, in the absence of adequate treatment, can be fatal. Cushing’s disease represents an unmet medical need, with no approved medical therapies. Pasireotide is a...

  • Medical Treatment in Cushing’s Syndrome: Dopamine Agonists and Cabergoline. Petrossians, Patrick; Thonnard, Anne-Sophie; Beckers, Albert // Neuroendocrinology;Sep2010 Supplement, Vol. 92, p116 

    Dopamine (DA) is a catecholamine with a wide range of functions and whose five subtype receptors are found in different organs where they exert a mainly inhibitory action. Since this action may also appear in a number of secretory tumors in various locations, DA agonists have elicited some...

  • Ectopic Cushing's Syndrome due to an Adrenal Ganglioneuroma. Corcuff, Jean-Benoît; Deminiere, Colette; Trouillas, Jacqueline; Puel, Olivier; Perel, Yves; Barat, Pascal // Hormone Research in Paediatrics;Apr2010, Vol. 73 Issue 5, p405 

    Background: Cushing's syndrome (CS), rare in children, is due to pituitary or, less frequently, to adrenocortical tumors. Ectopic adrenocorticotropin (ACTH) secretion is exceptional. Method: A case of apparently ACTH-independent CS in a child is reported. Results: CS was due to an adrenal...

  • Pituitary Radiotherapy for Cushing’s Disease. Losa, Marco; Picozzi, Piero; Redaelli, Maria Grazia; Laurenzi, Andrea; Mortini, Pietro // Neuroendocrinology;Sep2010 Supplement, Vol. 92, p107 

    Background: The treatment of choice for Cushing’s disease is pituitary surgery. Second-line treatments include repeat pituitary surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. The most used modalities to irradiate patients with Cushing’s disease include...

  • Reversible posterior encephalopathy syndrome associated with micronodular adrenocortical disease and Cushing syndrome. Lodish, Maya; Patronas, Nicholas J.; Stratakis, Constantine A. // European Journal of Pediatrics;Jan2010, Vol. 169 Issue 1, p125 

    We report a 6-year-old girl with ACTH-independent Cushing syndrome secondary to bilateral adrenal hyperplasia; she presented with hypertension and seizures, and magnetic resonance imaging shows changes consistent with posterior reversible encephalopathy syndrome.

  • Cushing’s Syndrome Due to Ectopic Adrenocorticotropic Hormone Production Secondary to Hepatic Carcinoid: Diagnosis, Treatment, and Improved Quality of Life. Coe, Susan G.; Tan, Winston W.; Fox, Thomas P. // JGIM: Journal of General Internal Medicine;Jun2008, Vol. 23 Issue 6, p875 

    We describe a previously healthy 40-year-old woman with Cushing’s syndrome caused by adrenocorticotropic hormone (ACTH) secretion from metastatic carcinoid. Over a 2-year period, the patient had multiple hospitalizations for uncontrolled hypertension, hyperglycemia, and hypokalemia. She...

  • Transsphenoidal surgery in Cushing disease: The challenging microadenoma (Local experience). Zakaria, Wael K.; Taha, Ahmed N. // Romanian Neurosurgery;Mar2018, Vol. 32 Issue 1, p116 

    Background: Cushing disease is uncommon challenging disease. The adenomas are usually small in size in most case making the disease diagnosis and management is sometimes difficult. In some cases, the tumor cannot be identified on imaging studies and in many cases the adenoma is eccentric in...

  • Cushing’s Disease in a 7-Month-Old Girl due to a Tumor Producing Adrenocorticotropic Hormone and Thyreotropin-Secreting Hormone. List, Jörg. V.; Sobottka, S.; Huebner, A.; Bonk, C.; Koy, J.; Pinzer, T.; Schackert, G. // Pediatric Neurosurgery;Jul99, Vol. 31 Issue 1, p7 

    We present the case of a 7-month-old baby with Cushing’s disease due to an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma combined with cells producing thyreotropin-secreting hormone (TSH). In MRI scans, a contrast-enhancing lesion was seen inside the pituitary fossa, and...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics