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- Papakokkinou, Eleni
(författare)
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Clinical challenges in Cushing's syndrome
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cushing’s syndrome (CS) is caused by prolonged exposure to cortisol excess. CS is associated with cardiovascular diseases, infections, and fractures, as well as with cognitive impairment and affective disorders. This thesis, based on four studies, aimed to investigate various aspects of the management of CS: the diagnostic work-up as well as the morbidity after successful treatment. A retrospective analysis on the usefulness of adrenal venous sampling (AVS) in patients with cortisol excess and bilateral adrenal lesions or morphologically normal adrenal glands, showed that AVS contributed to the decision-making of the treatment in two out of ten patients (Paper I). In a cross-sectional study, patients with CS in remission experienced mental fatigue and had impaired executive function, assessed with the self-administrated Mental Fatigue Scale (MFS) and Trail Making Test (TMT), respectively (Paper II). In a nationwide population-based study, excess morbidity was found in patients with pituitary CS (Cushing’s disease, CD). A more than 3-fold increased incidence of stroke, thromboembolism, and sepsis was found even in remission compared to the background population (Paper III). A systematic review and meta-analysis on patients with CD treated with bilateral adrenalectomy showed that every fourth patient developed progression or new onset of a pituitary tumor (Nelson’s syndrome, NS) and every fifth patient received treatment for NS. Also, NS occurred up to four decades after bilateral adrenalectomy (Paper IV). In conclusion, this thesis illustrates that patients with CS have excess morbidity due to stroke, thromboembolism, sepsis as well as cognitive impairment and mental fatigue despite treatment. Also, this thesis highlights the need for life-long follow-up of patients with CS. Despite the major progress achieved in the management of patients with CS, there are still challenges to overcome, both in the diagnostic work-up and treatment.
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| 2. |
- Piasecka, Marta, 1982, et al.
(författare)
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Is ectopic Cushing's syndrome underdiagnosed in patients with small cell lung cancer?
- 2022
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Ingår i: Frontiers in medicine. - : Frontiers Media SA. - 2296-858X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionEctopic Cushing's syndrome (ECS) is an uncommon disorder. Recently, however, a larger proportion of patients with endogenous Cushing's syndrome (CS) had ECS than has previously been reported. ObjectiveThe aim of this study was to determine whether ECS is an underdiagnosed disorder in patients with small-cell lung cancer (SCLC). Materials and methodsMedical records from consecutive patients diagnosed with SCLC at our hospital between 2013 and 2019 were reviewed (N = 213; mean age 69.5 +/- 9 years; range, 36-89 years). The probability of having ECS was evaluated by review of biochemical and clinical features, including presence of recent onset diabetes mellitus, therapy resistant hypertension and/or spontaneous hypokalaemia. ResultsOf 213 identified patients with SCLC, one (0.5%) patient had confirmed ECS, two (1%) patients had probable ECS, and twenty-three (11%) patients had possibly ECS. Patients with SCLC and possibly or probable ECS exhibited a significantly shorter survival than patients only with SCLC (8 vs. 14 months, respectively). ConclusionsOur findings indicate that ECS is underdiagnosed in patients with SCLC. Given the serious consequences of untreated ECS, the low detection rate highlights the need to improve endocrine work-up of patients with SCLC who present with biochemical and clinical features associated with ECS. Prospective studies are needed to establish a reliable assessment of the incidence of ECS and to optimise early detection strategies.
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