Clinical, biochemical and imaging characteristics of Cushing's macroadenomas and their long-term treatment outcome
Summary Objective Cushing's macroadenoma as a cause of Cushing's disease is less common than microadenoma. The data on nature and behaviour of Cushing's macroadenoma are limited to a few case series. We studied clinical, biochemical and imaging characteristics of macroadenoma and thei...
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| Veröffentlicht in: | Clinical endocrinology (Oxford) 2014-09, Vol.81 (3), p.336-342 |
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| creator | Kakade, Harshal Ramesh Kasaliwal, Rajeev Khadilkar, Kranti S. Jadhav, Swati Bukan, Amol Khare, Shruti Budyal, Sweta R. Goel, Atul Lila, Anurag R. Bandgar, Tushar Shah, Nalini S. |
| description | Summary
Objective
Cushing's macroadenoma as a cause of Cushing's disease is less common than microadenoma. The data on nature and behaviour of Cushing's macroadenoma are limited to a few case series. We studied clinical, biochemical and imaging characteristics of macroadenoma and their long‐term treatment outcomes.
Method
Retrospective analysis of 40 patients with macroadenoma managed at our centre from 1997 to 2013.
Results
Of 40 patients, there were 15 (37·5%) males and 25 (62·5%) females. Mean age at presentation was 26·7 ± 9·3 years. Visual field defects and/or cranial nerve palsies were found in 15 cases at presentation. Mean maximum tumour dimension was 20·83 ± 10·74 mm, and parasellar extension was seen in 25 (62·5%) patients. Plasma ACTH/maximum tumour dimension and 8 am serum cortisol/maximum tumour dimension decreased with increasing tumour size. Sixteen patients (40%) had remission (4: immediate, 12: delayed) after first transsphenoidal surgery (TSS). Larger tumour size and parasellar extension were predictors of failure to achieve remission. Four patients relapsed; noticeably all of them had delayed remission. Among the persistent and relapsed cases, second TSS was successful in two of eight patients, whereas 11 of 16 patients achieved remission after a mean duration of 12·14 ± 8·41 months postradiotherapy.
Conclusion
Younger age at presentation and larger tumour size compared with previous series were distinctive features of our series. Large tumour size and parasellar extension were negative predictors of surgical remission. Delayed remission was seen in significant proportion of patients, but one‐third later relapsed. Radiotherapy was an effective second‐line treatment modality. |
| doi_str_mv | 10.1111/cen.12442 |
| format | Article |
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Objective
Cushing's macroadenoma as a cause of Cushing's disease is less common than microadenoma. The data on nature and behaviour of Cushing's macroadenoma are limited to a few case series. We studied clinical, biochemical and imaging characteristics of macroadenoma and their long‐term treatment outcomes.
Method
Retrospective analysis of 40 patients with macroadenoma managed at our centre from 1997 to 2013.
Results
Of 40 patients, there were 15 (37·5%) males and 25 (62·5%) females. Mean age at presentation was 26·7 ± 9·3 years. Visual field defects and/or cranial nerve palsies were found in 15 cases at presentation. Mean maximum tumour dimension was 20·83 ± 10·74 mm, and parasellar extension was seen in 25 (62·5%) patients. Plasma ACTH/maximum tumour dimension and 8 am serum cortisol/maximum tumour dimension decreased with increasing tumour size. Sixteen patients (40%) had remission (4: immediate, 12: delayed) after first transsphenoidal surgery (TSS). Larger tumour size and parasellar extension were predictors of failure to achieve remission. Four patients relapsed; noticeably all of them had delayed remission. Among the persistent and relapsed cases, second TSS was successful in two of eight patients, whereas 11 of 16 patients achieved remission after a mean duration of 12·14 ± 8·41 months postradiotherapy.
Conclusion
Younger age at presentation and larger tumour size compared with previous series were distinctive features of our series. Large tumour size and parasellar extension were negative predictors of surgical remission. Delayed remission was seen in significant proportion of patients, but one‐third later relapsed. Radiotherapy was an effective second‐line treatment modality.</description><identifier>ISSN: 0300-0664</identifier><identifier>EISSN: 1365-2265</identifier><identifier>DOI: 10.1111/cen.12442</identifier><identifier>PMID: 24576201</identifier><identifier>CODEN: CLECAP</identifier><language>eng</language><publisher>Oxford: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Adrenals. Adrenal axis. Renin-angiotensin system (diseases) ; Adult ; Biological and medical sciences ; Child ; Cushing Syndrome - diagnosis ; Cushing Syndrome - metabolism ; Endocrinopathies ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Male ; Medical sciences ; Middle Aged ; Non tumoral diseases. Target tissue resistance. Benign neoplasms ; Pituitary ACTH Hypersecretion - diagnosis ; Pituitary ACTH Hypersecretion - metabolism ; Pituitary ACTH Hypersecretion - radiotherapy ; Pituitary ACTH Hypersecretion - surgery ; Retrospective Studies ; Vertebrates: endocrinology ; Young Adult</subject><ispartof>Clinical endocrinology (Oxford), 2014-09, Vol.81 (3), p.336-342</ispartof><rights>2014 John Wiley & Sons Ltd</rights><rights>2015 INIST-CNRS</rights><rights>2014 John Wiley & Sons Ltd.</rights><rights>Copyright © 2014 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4912-367d56aa5b7b1724372cabdaf845a3cb3af40101d2d99c75a6fe50b903c237563</citedby><cites>FETCH-LOGICAL-c4912-367d56aa5b7b1724372cabdaf845a3cb3af40101d2d99c75a6fe50b903c237563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcen.12442$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcen.12442$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28677321$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24576201$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kakade, Harshal Ramesh</creatorcontrib><creatorcontrib>Kasaliwal, Rajeev</creatorcontrib><creatorcontrib>Khadilkar, Kranti S.</creatorcontrib><creatorcontrib>Jadhav, Swati</creatorcontrib><creatorcontrib>Bukan, Amol</creatorcontrib><creatorcontrib>Khare, Shruti</creatorcontrib><creatorcontrib>Budyal, Sweta R.</creatorcontrib><creatorcontrib>Goel, Atul</creatorcontrib><creatorcontrib>Lila, Anurag R.</creatorcontrib><creatorcontrib>Bandgar, Tushar</creatorcontrib><creatorcontrib>Shah, Nalini S.</creatorcontrib><title>Clinical, biochemical and imaging characteristics of Cushing's macroadenomas and their long-term treatment outcome</title><title>Clinical endocrinology (Oxford)</title><addtitle>Clin Endocrinol</addtitle><description>Summary
Objective
Cushing's macroadenoma as a cause of Cushing's disease is less common than microadenoma. The data on nature and behaviour of Cushing's macroadenoma are limited to a few case series. We studied clinical, biochemical and imaging characteristics of macroadenoma and their long‐term treatment outcomes.
Method
Retrospective analysis of 40 patients with macroadenoma managed at our centre from 1997 to 2013.
Results
Of 40 patients, there were 15 (37·5%) males and 25 (62·5%) females. Mean age at presentation was 26·7 ± 9·3 years. Visual field defects and/or cranial nerve palsies were found in 15 cases at presentation. Mean maximum tumour dimension was 20·83 ± 10·74 mm, and parasellar extension was seen in 25 (62·5%) patients. Plasma ACTH/maximum tumour dimension and 8 am serum cortisol/maximum tumour dimension decreased with increasing tumour size. Sixteen patients (40%) had remission (4: immediate, 12: delayed) after first transsphenoidal surgery (TSS). Larger tumour size and parasellar extension were predictors of failure to achieve remission. Four patients relapsed; noticeably all of them had delayed remission. Among the persistent and relapsed cases, second TSS was successful in two of eight patients, whereas 11 of 16 patients achieved remission after a mean duration of 12·14 ± 8·41 months postradiotherapy.
Conclusion
Younger age at presentation and larger tumour size compared with previous series were distinctive features of our series. Large tumour size and parasellar extension were negative predictors of surgical remission. Delayed remission was seen in significant proportion of patients, but one‐third later relapsed. Radiotherapy was an effective second‐line treatment modality.</description><subject>Adolescent</subject><subject>Adrenals. Adrenal axis. Renin-angiotensin system (diseases)</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Cushing Syndrome - diagnosis</subject><subject>Cushing Syndrome - metabolism</subject><subject>Endocrinopathies</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Non tumoral diseases. Target tissue resistance. Benign neoplasms</subject><subject>Pituitary ACTH Hypersecretion - diagnosis</subject><subject>Pituitary ACTH Hypersecretion - metabolism</subject><subject>Pituitary ACTH Hypersecretion - radiotherapy</subject><subject>Pituitary ACTH Hypersecretion - surgery</subject><subject>Retrospective Studies</subject><subject>Vertebrates: endocrinology</subject><subject>Young Adult</subject><issn>0300-0664</issn><issn>1365-2265</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd9r1TAUx4Mo7jp98B-QgIgT1i0_mqR9lLJN2Zg-TPQtnKbpvZltMpMW3X9vunu3gWBeQjif7zkn3y9Cryk5ovkcG-uPKCtL9gStKJeiYEyKp2hFOCEFkbLcQy9SuiaEiIqo52iPlUJJRugKxWZw3hkYDnHrgtnYcXlg8B12I6ydX2OzgQhmstGlyZmEQ4-bOW1y6X3CI5gYoLM-jJDuZNPGuoiH4NdF1ox4iham0foJh3kyYbQv0bMehmRf7e599O305Kr5VFx8OfvcfLwoTFlTVnCpOiEBRKtaqljJFTPQdtBXpQBuWg59SSihHevq2igBsreCtDXhhnElJN9HB9u-NzH8mm2a9OiSscMA3oY5aSryHFVJRTP69h_0OszR5-0WqmKsKuXS8MOWyl9OKdpe38RsUrzVlOglCJ2D0HdBZPbNruPcjrZ7IO-dz8C7HQApO95H8MalRy7vpThbuOMt99sN9vb_E3Vzcnk_utgqcl72z4MC4k8tVXZGf7880_X5j6_8XFF9xf8Cz7St7Q</recordid><startdate>201409</startdate><enddate>201409</enddate><creator>Kakade, Harshal Ramesh</creator><creator>Kasaliwal, Rajeev</creator><creator>Khadilkar, Kranti S.</creator><creator>Jadhav, Swati</creator><creator>Bukan, Amol</creator><creator>Khare, Shruti</creator><creator>Budyal, Sweta R.</creator><creator>Goel, Atul</creator><creator>Lila, Anurag R.</creator><creator>Bandgar, Tushar</creator><creator>Shah, Nalini S.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201409</creationdate><title>Clinical, biochemical and imaging characteristics of Cushing's macroadenomas and their long-term treatment outcome</title><author>Kakade, Harshal Ramesh ; Kasaliwal, Rajeev ; Khadilkar, Kranti S. ; Jadhav, Swati ; Bukan, Amol ; Khare, Shruti ; Budyal, Sweta R. ; Goel, Atul ; Lila, Anurag R. ; Bandgar, Tushar ; Shah, Nalini S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4912-367d56aa5b7b1724372cabdaf845a3cb3af40101d2d99c75a6fe50b903c237563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adrenals. Adrenal axis. Renin-angiotensin system (diseases)</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Cushing Syndrome - diagnosis</topic><topic>Cushing Syndrome - metabolism</topic><topic>Endocrinopathies</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Non tumoral diseases. Target tissue resistance. Benign neoplasms</topic><topic>Pituitary ACTH Hypersecretion - diagnosis</topic><topic>Pituitary ACTH Hypersecretion - metabolism</topic><topic>Pituitary ACTH Hypersecretion - radiotherapy</topic><topic>Pituitary ACTH Hypersecretion - surgery</topic><topic>Retrospective Studies</topic><topic>Vertebrates: endocrinology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kakade, Harshal Ramesh</creatorcontrib><creatorcontrib>Kasaliwal, Rajeev</creatorcontrib><creatorcontrib>Khadilkar, Kranti S.</creatorcontrib><creatorcontrib>Jadhav, Swati</creatorcontrib><creatorcontrib>Bukan, Amol</creatorcontrib><creatorcontrib>Khare, Shruti</creatorcontrib><creatorcontrib>Budyal, Sweta R.</creatorcontrib><creatorcontrib>Goel, Atul</creatorcontrib><creatorcontrib>Lila, Anurag R.</creatorcontrib><creatorcontrib>Bandgar, Tushar</creatorcontrib><creatorcontrib>Shah, Nalini S.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical endocrinology (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kakade, Harshal Ramesh</au><au>Kasaliwal, Rajeev</au><au>Khadilkar, Kranti S.</au><au>Jadhav, Swati</au><au>Bukan, Amol</au><au>Khare, Shruti</au><au>Budyal, Sweta R.</au><au>Goel, Atul</au><au>Lila, Anurag R.</au><au>Bandgar, Tushar</au><au>Shah, Nalini S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical, biochemical and imaging characteristics of Cushing's macroadenomas and their long-term treatment outcome</atitle><jtitle>Clinical endocrinology (Oxford)</jtitle><addtitle>Clin Endocrinol</addtitle><date>2014-09</date><risdate>2014</risdate><volume>81</volume><issue>3</issue><spage>336</spage><epage>342</epage><pages>336-342</pages><issn>0300-0664</issn><eissn>1365-2265</eissn><coden>CLECAP</coden><abstract>Summary
Objective
Cushing's macroadenoma as a cause of Cushing's disease is less common than microadenoma. The data on nature and behaviour of Cushing's macroadenoma are limited to a few case series. We studied clinical, biochemical and imaging characteristics of macroadenoma and their long‐term treatment outcomes.
Method
Retrospective analysis of 40 patients with macroadenoma managed at our centre from 1997 to 2013.
Results
Of 40 patients, there were 15 (37·5%) males and 25 (62·5%) females. Mean age at presentation was 26·7 ± 9·3 years. Visual field defects and/or cranial nerve palsies were found in 15 cases at presentation. Mean maximum tumour dimension was 20·83 ± 10·74 mm, and parasellar extension was seen in 25 (62·5%) patients. Plasma ACTH/maximum tumour dimension and 8 am serum cortisol/maximum tumour dimension decreased with increasing tumour size. Sixteen patients (40%) had remission (4: immediate, 12: delayed) after first transsphenoidal surgery (TSS). Larger tumour size and parasellar extension were predictors of failure to achieve remission. Four patients relapsed; noticeably all of them had delayed remission. Among the persistent and relapsed cases, second TSS was successful in two of eight patients, whereas 11 of 16 patients achieved remission after a mean duration of 12·14 ± 8·41 months postradiotherapy.
Conclusion
Younger age at presentation and larger tumour size compared with previous series were distinctive features of our series. Large tumour size and parasellar extension were negative predictors of surgical remission. Delayed remission was seen in significant proportion of patients, but one‐third later relapsed. Radiotherapy was an effective second‐line treatment modality.</abstract><cop>Oxford</cop><pub>Blackwell Publishing Ltd</pub><pmid>24576201</pmid><doi>10.1111/cen.12442</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adrenals. Adrenal axis. Renin-angiotensin system (diseases) Adult Biological and medical sciences Child Cushing Syndrome - diagnosis Cushing Syndrome - metabolism Endocrinopathies Female Fundamental and applied biological sciences. Psychology Humans Male Medical sciences Middle Aged Non tumoral diseases. Target tissue resistance. Benign neoplasms Pituitary ACTH Hypersecretion - diagnosis Pituitary ACTH Hypersecretion - metabolism Pituitary ACTH Hypersecretion - radiotherapy Pituitary ACTH Hypersecretion - surgery Retrospective Studies Vertebrates: endocrinology Young Adult |
| title | Clinical, biochemical and imaging characteristics of Cushing's macroadenomas and their long-term treatment outcome |
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