Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome

Detalhes bibliográficos
Autor(a) principal: Cohen,Ana C.
Data de Publicação: 2019
Outros Autores: Goldney,Dolores Clifton, Danilowicz,Karina, Manavela,Marcos, Rossi,María A., Gómez,Reynaldo M., Cross,Graciela E., Bruno,Oscar D.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Arquivos de Endocrinologia e Metabolismo (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000800470
Resumo: ABSTRACT Objective We analyzed the clinical, biochemical, and imaging findings of adrenalectomized patients with Cushing’s disease (CD) in order to compare the characteristics of those who developed Nelson’s syndrome (NS) versus those who did not develop this complication (NNS), aiming to identify possible predictive factors for its occurrence. Subjects and methods We performed a retrospective review of the clinical records of a group of patients with CD who underwent TBA between 1974 and 2011. Results Out of 179 patients with CD, 13 (7.3%) underwent TBA. NS occurred in 6 of them (46%) after a mean of 24 months from the total bilateral adrenalectomy (TBA). Age at diagnosis, duration of Cushing’s syndrome (CS) until TBA, and steroid replacement doses were similar in both groups. Initial urinary cortisol levels (24-hour urinary free cortisol [UFC]) were significantly higher in the NS group than in the NNS group (p = 0.009). Four patients in the NS group and three of those in the NNS group received radiotherapy before TBA (p = 0.26). Three patients in the NS group presented residual tumors before TBA, compared with none in the NNS group (p = 0.04). At 1 year after TBA, the median ACTH level was 476 ng/L (240-1500 ng/L) in the NS group and 81 ng/L (48-330 ng/L) in the NNS group (p = 0.0007). Conclusion In conclusion, a residual tumor before TBA, higher 24-hour UFC at diagnosis, and increasing ACTH levels within 1 year after TBA emerged as predictive factors of development of NS.
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spelling Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndromeCushing’s diseasecorticotrophinomaNelson’s syndromebilateral adrenalectomyABSTRACT Objective We analyzed the clinical, biochemical, and imaging findings of adrenalectomized patients with Cushing’s disease (CD) in order to compare the characteristics of those who developed Nelson’s syndrome (NS) versus those who did not develop this complication (NNS), aiming to identify possible predictive factors for its occurrence. Subjects and methods We performed a retrospective review of the clinical records of a group of patients with CD who underwent TBA between 1974 and 2011. Results Out of 179 patients with CD, 13 (7.3%) underwent TBA. NS occurred in 6 of them (46%) after a mean of 24 months from the total bilateral adrenalectomy (TBA). Age at diagnosis, duration of Cushing’s syndrome (CS) until TBA, and steroid replacement doses were similar in both groups. Initial urinary cortisol levels (24-hour urinary free cortisol [UFC]) were significantly higher in the NS group than in the NNS group (p = 0.009). Four patients in the NS group and three of those in the NNS group received radiotherapy before TBA (p = 0.26). Three patients in the NS group presented residual tumors before TBA, compared with none in the NNS group (p = 0.04). At 1 year after TBA, the median ACTH level was 476 ng/L (240-1500 ng/L) in the NS group and 81 ng/L (48-330 ng/L) in the NNS group (p = 0.0007). Conclusion In conclusion, a residual tumor before TBA, higher 24-hour UFC at diagnosis, and increasing ACTH levels within 1 year after TBA emerged as predictive factors of development of NS.Sociedade Brasileira de Endocrinologia e Metabologia2019-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000800470Archives of Endocrinology and Metabolism v.63 n.5 2019reponame:Arquivos de Endocrinologia e Metabolismo (Online)instname:Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)instacron:SBEM10.20945/2359-3997000000144info:eu-repo/semantics/openAccessCohen,Ana C.Goldney,Dolores CliftonDanilowicz,KarinaManavela,MarcosRossi,María A.Gómez,Reynaldo M.Cross,Graciela E.Bruno,Oscar D.eng2019-10-08T00:00:00Zoai:scielo:S2359-39972019000800470Revistahttps://www.aem-sbem.com/https://old.scielo.br/oai/scielo-oai.php||aem.editorial.office@endocrino.org.br2359-42922359-3997opendoar:2019-10-08T00:00Arquivos de Endocrinologia e Metabolismo (Online) - Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)false
dc.title.none.fl_str_mv Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
title Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
spellingShingle Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
Cohen,Ana C.
Cushing’s disease
corticotrophinoma
Nelson’s syndrome
bilateral adrenalectomy
title_short Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
title_full Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
title_fullStr Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
title_full_unstemmed Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
title_sort Long-term outcome after bilateral adrenalectomy in Cushing’s disease with focus on Nelson’s syndrome
author Cohen,Ana C.
author_facet Cohen,Ana C.
Goldney,Dolores Clifton
Danilowicz,Karina
Manavela,Marcos
Rossi,María A.
Gómez,Reynaldo M.
Cross,Graciela E.
Bruno,Oscar D.
author_role author
author2 Goldney,Dolores Clifton
Danilowicz,Karina
Manavela,Marcos
Rossi,María A.
Gómez,Reynaldo M.
Cross,Graciela E.
Bruno,Oscar D.
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Cohen,Ana C.
Goldney,Dolores Clifton
Danilowicz,Karina
Manavela,Marcos
Rossi,María A.
Gómez,Reynaldo M.
Cross,Graciela E.
Bruno,Oscar D.
dc.subject.por.fl_str_mv Cushing’s disease
corticotrophinoma
Nelson’s syndrome
bilateral adrenalectomy
topic Cushing’s disease
corticotrophinoma
Nelson’s syndrome
bilateral adrenalectomy
description ABSTRACT Objective We analyzed the clinical, biochemical, and imaging findings of adrenalectomized patients with Cushing’s disease (CD) in order to compare the characteristics of those who developed Nelson’s syndrome (NS) versus those who did not develop this complication (NNS), aiming to identify possible predictive factors for its occurrence. Subjects and methods We performed a retrospective review of the clinical records of a group of patients with CD who underwent TBA between 1974 and 2011. Results Out of 179 patients with CD, 13 (7.3%) underwent TBA. NS occurred in 6 of them (46%) after a mean of 24 months from the total bilateral adrenalectomy (TBA). Age at diagnosis, duration of Cushing’s syndrome (CS) until TBA, and steroid replacement doses were similar in both groups. Initial urinary cortisol levels (24-hour urinary free cortisol [UFC]) were significantly higher in the NS group than in the NNS group (p = 0.009). Four patients in the NS group and three of those in the NNS group received radiotherapy before TBA (p = 0.26). Three patients in the NS group presented residual tumors before TBA, compared with none in the NNS group (p = 0.04). At 1 year after TBA, the median ACTH level was 476 ng/L (240-1500 ng/L) in the NS group and 81 ng/L (48-330 ng/L) in the NNS group (p = 0.0007). Conclusion In conclusion, a residual tumor before TBA, higher 24-hour UFC at diagnosis, and increasing ACTH levels within 1 year after TBA emerged as predictive factors of development of NS.
publishDate 2019
dc.date.none.fl_str_mv 2019-10-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000800470
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.20945/2359-3997000000144
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Endocrinologia e Metabologia
publisher.none.fl_str_mv Sociedade Brasileira de Endocrinologia e Metabologia
dc.source.none.fl_str_mv Archives of Endocrinology and Metabolism v.63 n.5 2019
reponame:Arquivos de Endocrinologia e Metabolismo (Online)
instname:Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)
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instname_str Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)
instacron_str SBEM
institution SBEM
reponame_str Arquivos de Endocrinologia e Metabolismo (Online)
collection Arquivos de Endocrinologia e Metabolismo (Online)
repository.name.fl_str_mv Arquivos de Endocrinologia e Metabolismo (Online) - Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)
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