Itsenko-Cushing’s disease in the practice of a nurse
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Abstract:
Itsenko-Cushing’s disease is a disease characterized by dysfunctions of the hypothalamic-pituitary-adrenal system. Without therapy during the first five years, the survival rate is 50 %, and the patient’s condition improves markedly with palliative treatment, increasing the survival rate to 86 %. Today, there are a number of criteria for the diagnosis, diagnosis and treatment of this pathology.Keywords:
Cushing Disease
Cushing's disease
Cure rate
Cushing's disease
Corticotropic cell
Drug-naïve
Cushing Disease
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Cushing's disease
Cushing Disease
Bilateral adrenalectomy
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Cyclic Cushing's disease is a rare clinical entity that is defined as a periodic excessive production of adrenocorticotropic hormone (ACTH) and cortisol. Only 42 cases with cyclic Cushing's disease have been reported in the literature. The diagnosis is very difficult because of the fluctuating secretion of ACTH and cortisol. We report a 78-year-old woman with a pituitary adenoma presenting with cyclic Cushing's disease. In the present case, several interesting issues are pointed out: 1) MRI study detected the presence of an adenoma and selective venous sampling in the cavernous sinus disclosed the hypersecretion of ACTH from a pituitary adenoma. These neuroimaging and endocrinological studies were helpful for the diagnosis, even in the remission phase. 2) The disease was in the long-term remission phase after transsphenoidal surgery despite the high recurrence rate in this clinical entity, although it recurred four years later. Even in the remission phase of cyclic Cushing's disease, meticulous endocrinological and neuroimaging examinations can reveal the presence of a pituitary adenoma, which should be treated surgically.
Cushing's disease
Cushing Disease
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Cushing’s Disease is caused by pituitary adenoma which produces adrenocorticotropic hormone causing hypercortisolemia. First-line treatment involves operative removal of the tumor, however, in some patients it proves ineffective. In those cases, pharmacological treatment is necessary as untreated Cushing’s Disease may be lethal. In 2020 a new steroidogenesis inhibitor – Osilodrostat - was approved by the European Medicines Agency and can be used in the treatment of patients who cannot undergo pituitary surgery or whose previous surgical treatment proved ineffective.
We present a case of a 26-year-old female patient who was diagnosed with endogenous Cushing’s Disease and underwent two consecutive operations to remove the tumor - both were ineffective. With deteriorating laboratory results and other pharmacological treatments exhausted Osilodrostat therapy was introduced.
Osilodrostat is becoming an important drug in patients with Cushing’s Disease refractory to other treatments.
Hypercortisolemia
Cushing's disease
Cushing Disease
Refractory (planetary science)
Pituitary Tumors
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Cushing's disease
Cushing Disease
Concomitant
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Over 70% of cases of Cushing's syndrome are caused by an ACTH-secreting pituitary tumor, known as Cushing's disease.[1] An early predictor for long-term remission of Cushing's disease after surgery has received substantial interest in the neurosurgical and endocrinological literatures.[2] While previous studies have examined the predictive value of early postoperative ACTH levels, intraoperative ACTH levels have not been evaluated. We examined intraoperative ACTH levels and describe a highly sensitive and specific predictor for long-term remission in a subset of Cushing's patients.
Cushing's disease
Cushing Disease
Transsphenoidal surgery
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Cushing's disease
Transsphenoidal surgery
Cushing Disease
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Cushing's disease (CD) is caused by a pituitary adenoma secreting corticotrophin (ACTH) that leads to cortisol excess. Despite a characteristic clinical picture, it is often difficult to make a proper diagnosis, as it requires complex and long-lasting diagnostic procedures. Selective transsphenoidal surgery (TSS) remains the treatment of choice for CD. Untreated or improperly treated Cushing's disease leads to the development of serious complications, which lower patients' quality of life. Mortality in this group is high, reaching 50% within a 5-year follow-up period. In this study, we present our own experience and discuss the importance of preoperative hormone measurements, magnetic resonance imaging (MRI) of the pituitary, results of histopathological examination (immunohistochemical and ultrastructural in electron microscopy) and postoperative early and late hormonal assessment in the aspect of TSS efficacy. The performed analysis is based on the current criteria for remission of Cushing's disease. Our study emphasises the need for long-term postoperative endocrinological follow-up, which facilitates early detection of recurrent hypercortisolemia.
Cushing's disease
Hypercortisolemia
Transsphenoidal surgery
Cushing Disease
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Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
Cushing's disease
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Objective To investigate the effect of transsphenoidal surgery for the Cushing's disease. Methods A total of 122 patients with Cushing's disease admitted in our department from January 2009 to November 2012 were analyzed retrospectively. Pre-operative and post-operative hormonal levels were tested. Results The remission rate was 90. 9%. There is a significant difference between remission group and non- remission group in the plasma cortisol levels at different time points post-operatively.( P 0. 05),however, 24 h urinary free cortisol level just at the time of 1 to 2 d and 3 ～ 6 months post-operation showed significant differences( P 0. 05). Conclusion Transsphenoidal surgery is an effective method for the treatment of Cushing's disease. After transsphenoidal surgery,the prognosis can be judged by post-operative plasma cortisol level,24 h urinary free cortisol level and adrenocoticotropic hormone level.
Transsphenoidal surgery
Cushing's disease
Cushing Disease
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