How do Cushing’s syndrome patients perceive the quality of their diagnosis and their management? Could we be doing better?

Six decades of clinical use, accompanied by number of prospective and retrospective studies, have established metyrapone as an effective treatment for Cushing's syndrome. What new information will you glean from this helpful, question and answer format, review?

This review explains the recent work of Walia et al. 2021, who have used a novel imaging technique to correctly identify adenomas, some of which were negative on MRI or of ectopic origin. Could this study eventually change how we diagnose CD?

This novel, non-invasive molecular imaging technique potentially expands current diagnostic capabilities – will you investigate?

Findings from this literature review suggest using a stepwise approach to performing IPSS and interpreting the results. How might your practice be influenced?

This study attempts to establish a causal relationship between hypercortisolism and AF but what were the precise findings and likely mediators?

This study evaluated psychiatric and neurocognitive functions in adrenal incidentaloma patients with subclinical hypercortisolism. What recommendations can be made?

Mutations in the ATRX gene have been implicated in the development of several cancer types. This study examined the ATRX gene in APTs and PCs – what were the findings, and could new techniques identify patients at high risk?

This study measured hair cortisol and cortisone in a variety of patients with Cushing's syndrome. Are these measurements of diagnostic value in patients with mild disease?

While full blood count and serum inflammation-based scores reflect systemic inflammation and predict outcomes in cancer, are these biochemical data of similar value in the treatment of pituitary adenomas?

Current medical therapies for CD by and large exert no action on tumour growth – could this be about to change?

While there is still no specific medical treatment for Carney complex, what advances have been made in our understanding of this disorder and what recommendations can be made?

The adverse effects of chronic exposure to hypercortisolism on the human brain remain unclear.  This study correlated MRI findings with neuropsychological testing and clinical examination in 97 active and remitted CS patients. What was learned?

This study looked at individual Insulin-like growth factor I concentrations 6 months after curative surgery for Cushing's syndrome. What were the correlations with adverse long-term myopathy outcomes?

This longitudinal cohort study examined the SMRs of 191 CD patients initially presenting with pituitary adenoma. What were the independent risk factors related to increased mortality in this group?

This study compared the in vitro effects of racemic ketoconazole with levoketoconazole on adrenocortical and pituitary adenoma cells. What effects were seen?

Results of this study suggests a close association between chromosome instability and aggressive corticotroph tumour behaviour. Could these findings lead to the identification of high-risk tumours and, in turn, a new system of classification?

Experts from the USA, Canada and Austria explore the risk assessment and management of severe complications of Cushing’s disease. What will you learn from this case-based guide?

This single-center retrospective cohort study examined the records of 123 adult patients seen between 1985 and 2018. What biochemical correlations were found and what degree of thyroid function was restored after successful treatment of Cushing’s syndrome?

Can you predict the likelihood of younger patients remaining overweight or obese following successful treatment and what, if anything, can be done to intervene?

What is the impact of levoketoconazole treatment on quality-of-life scores, depression, and specific clinical signs and symptoms characteristic of CS?

This paper describes a diagnostic algorithm for cyclic CS with special regard to hair cortisol analysis and the desmopressin stimulation test – could this tool facilitate faster diagnosis?

This systematic review examines the presence and severity of neuropsychological impairment in Cushing’s patients. What reassurance can be given to patients and what studies remain to be done?

This review article summarizes our current understanding of this rare disorder and includes definitions, pathology, and treatment options, together with a subset of tumors undergoing malignant transformation.

A total of 12 pregnant women who underwent adrenalectomy over a 15-year period were identified from a prospectively maintained database. Results show that while maternal outcome is acceptable, fetal outcome is influenced by several factors and is variable.

This is a retrospective case record analysis of 42 patients with Cushing’s Disease who underwent conventional fractionated radiotherapy (CFR) with at least 12 months follow-up. Results show that peri-CRT use of cabergoline is significantly associated with increased recurrence rates of disease.

This study pooled data from 255 patients across 10 institutions participating in the International Radiosurgery Research Foundation. Are endocrine remission rates most improved following early or late stereotactic radiosurgery?

This multicentre retrospective study of 95 patients with Cushing’s Disease, responding preoperatively to desmopressin test (DT) and with early post-operative corticotropic insufficiency (COI), underwent a DT within 3 months post-surgery. Results may help stratify patients with COI and refine their follow-up according to the risk of recurrence.

This study aimed to establish robust reference intervals for, and compare the diagnostic accuracy of, salivary cortisol and cortisone in late-night samples and after a low-dose dexamethasone suppression test. Will the results confirm the accuracy of late-night cortisol and cortisone testing?

This tertiary care center study, which looked at 43 patients over a 35-year period, analyzed clinical symptomatology, cortisol, ACTH, and radiology following total bilateral adrenalectomy. Could the findings lead to improved patient care, including a reduction in the need for frequent imaging?

This study of fourteen patients − with severe and complicated Cushing’s syndrome related to adrenal carcinoma or ectopic ACTH secretion − compared data from those treated with high starting doses of etomidate in ICU or with lower starting doses in non-ICU medical wards. Results suggest that low doses of etomidate in medical wards should be considered.

Primary pigmented nodular adrenocortical disease (PPNAD) and primary bilateral macronodular adrenocortical hyperplasia are linked to respective gene mutations. This study aims to determine the potential influence of ARMC5 genes – which have many non-pathological variants in the general population – on PRKAR1A mutations, the defect that causes PPNAD.  What was shown?

This review identified 91 articles, which included original articles, case reports and case series, reporting on 99 cases of ectopic adrenocorticotropic hormone and/or corticotrophin-releasing-hormone secreting pheochromocytomas. What do we currently know about disease characteristics, management, and outcomes in these patients?

Read the findings of the prospective, multicentre, open-label, double-blind randomized withdrawal period phase III study (LINC 3).

This cross-sectional study of 200 patients took place in a referral University Hospital Center from 2010 to 2019.  The human corticotropin-releasing hormone (CRH) test was performed mainly for the differential diagnosis of ACTH-dependent CS or adrenal lesions but what were the findings?

This study of 64 patients confirms earlier findings that tumor-to-liver standardized uptake value ratio (SUV)_max (>1.5) is a useful biomarker for the diagnosis of malignancy in adrenal masses but was a predictive model also identified?

This study was designed to identify predictive features of delayed post-operative disease remission using machine-based algorithms. Findings, which were based on 201 patients, identified a model with predictive ability that was significantly better than using Knosp grading and postoperative immediate morning serum cortisol alone. Could this effective approach lead to better patient care?

This case study highlights the importance of monitoring ACTH and corticotroph tumor size in patients with persistent Cushing’s syndrome, either under effective treatment with steroidogenesis inhibitors or after bilateral adrenalectomy.

This retrospective cohort study identified 1199 new adrenal Cushing’s syndrome patients presenting between 2002 and 2017. Results show a high risk of pre- and post-operative comorbidities. The major types of glucocorticoids prescribed are given.

Patients with ACTH-dependent Cushing's syndrome (n = 27) underwent 68-Ga CRH PET-CT. Information provided by medical imaging provided surgeons with valuable information for intraoperative tumor navigation, and helped in differentiating pituitary from extra-pituitary sources of ACTH-dependent CS.

Postoperative day 1 morning serum cortisol value is shown to be a helpful predictor of long-term disease recurrence in the statistical analysis of 260 patients with Cushing’s disease.

This longitudinal cohort study of patients with Cushing’s disease (1979−2018) identified the main predictors for mortality, which is mainly linked to cardiovascular disease.

This retrospective cohort study of 73 pediatric patients with Cushing’s disease analyzed BMI after long-term remission and determined predictive factors for those at risk of remaining overweight or obese following successful treatment.

This review article examines the use of adrenally acting medical therapies, including ketoconazole, metyrapone, osilodrostat, mitotane, and etomidate. Use of these drugs mandates adequate patient instruction and close monitoring to that ensure treatment goals are met while untoward adverse effects are minimized.

This cross-sectional study at a tertiary referral center examines 36 women in disease remission. The study aims to quantify the degree of fatty infiltration in thigh muscle and evaluate the relationship between these changes and physical performance.

This cross-sectional study with prospective enrolment (2014− 2019), involved 213 patients with adrenal adenomas, with and without Cushing’s syndrome. Bone turnover markers within three patient subgroups are discussed, together with the impact of adrenalectomy.

The aim of this meta-analysis, based on 5367 patients in different populations, is to assess the time span between first symptoms and diagnosis to identify what factors, if any, are associated with earlier rates of detection.

This is a retrospective study of 632 non-Cushing’s patients evaluated for adrenal incidentalomas. Results show that affected patients are at risk of atrial fibrillation. Do these findings have implications for Cushing’s disease?

This retrospective, nationwide study explored outcomes in 502 patients with confirmed Cushing’s disease identified in the Swedish National Patient Register between 1987 and 2013.

This retrospective study involving 194 patients at two centers tested a non-invasive diagnostic strategy associated with 100% positive predictive value for Cushing’s disease. Will this diagnostic algorithm eventually replace the highly invasive IPSS?

This retrospective cohort study of 123 adult patients at a clinical research center explores the prevalence of abnormal thyroid function in Cushing's syndrome and whether it is reversible after cure.

This follow-up study looks at the impact of surgery on bone mineral density and fracture rates in patients with confirmed Cushing's syndrome at the time of diagnosis and 2 years after successful tumor resection. Could successful surgery reduce the rate of Cushing’s-linked osteoporosis?

This review examines the potential role, and limitations, of the desmopressin test as an early and reliable predictive marker of long-term disease remission in surgical patients.

This review explains the recent advances in our understanding of hypothalamic-pituitary-adrenal axis regulation and the resulting emergence of a promising novel chronotherapy.

This single-center retrospective cohort study examined the records of 242 patients with Cushing’s syndrome highlighting the range of acute and life-threatening complications and their high prevalence, even before diagnosis and after successful surgery.

This review examines the complexity of clinical steroidogenesis inhibition from the establishment of initial dosage and drug scheduling to the monitoring of efficacy and side effects. Four agents are considered − ketoconazole, levoketoconazole, metyrapone and osilodrostat − in mono- and combination therapy.

This phase 2 trial analyzes whether metformin can improve metabolic profiles and clinical outcomes for glucocorticoid-treated patients with inflammatory disease.

This meta-analysis looks at remission and recurrence rates after trans-sphenoidal surgery, with a focus on factors predictive of remission.

An exploratory analysis looking at the use of late-night salivary cortisol (LNSC) to monitor pharmacological response to medical treatment in Cushing’s disease.

Expert review of diagnostic and therapeutic strategies surrounding ectopic ACTH syndrome, including currently available tools and comment on effectiveness of operational care via a multidisciplinary team.

A systematic review and associated guidance from the European Society of Endocrinology providing a rational approach to endocrine testing and treatment in people with obesity. Could this help optimize the diagnosis of Cushing syndrome?

This retrospective, single-center, longitudinal study looks at the prevalence of thrombotic events in patients with Cushing’s syndrome after surgical and medical treatment.

An observational study focusing on long-term muscle function, exploring how glucocorticoid-induced myopathy resolves following remission of endogenous Cushing’s syndrome.

Current medical therapies for Cushing’s disease do not generally have an action on tumor growth. High throughput screening using a novel ‘gain of signal’ adrenocorticotropic hormone (ACTH) assay is helping identify drugs that inhibit corticotroph tumor ACTH secretion and growth, which may be of promise in Cushing’s syndrome.

Patients with active Cushing's syndrome may be immunocompromised, and so require strict adherence to barrier methods to prevent infection with COVID-19. Clinical practice guidelines lay out the key principles of care of these patients during the pandemic, including algorithms for investigations and management of the syndrome.

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A multicenter study in patients with Nelson’s syndrome exploring the predictors of long-term prognosis and tumor progression.

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Ketoconazole is indicated in the European Union for the treatment of endogenous Cushing’s syndrome in adults and adolescents aged over 12.

Systematic review of 40 years of research in Cushing’s syndrome underlines the importance of annual clinical and biochemical follow-up.

ATRX mutations occur in a subset of aggressive pituitary tumors and are more common in corticotroph tumors. Could ATRX immunohistochemistry help identify patients at risk of developing aggressive and potentially metastatic pituitary tumors?

A subanalysis of the open-label phase 3 SONICS trial reports the impact of levoketoconazole treatment on clinical signs and symptoms, depression, patient-reported outcomes and quality of life.

Late-night salivary cortisol measured by enzyme immunoassay is a first-line screening test for Cushing syndrome with reported sensitivity and specificity of >90%. This study asked whether liquid chromatography-tandem mass spectrometry to measure salivary cortisol and cortisone could improve the sensitivity of this test.

It is still unclear which diagnostic tests for Cushing’s syndrome are the most accurate. This study employs meta-analytical techniques to compare the sensitivity and specificity of the most common diagnostic tests.

Two consecutive clinical cases on hepatic function in Cushing syndrome patients receiving concomitant ketoconazole and PD-1 inhibitor.