Publication Highlights

Differentiating between neoplastic and nonneoplastic hypercortisolaemia can be challenging. This Publication Highlight summarises work by Findling and Raff on the likelihood of cortisol excess having a neoplastic or nonneoplastic origin.

The impact of Cushing’s syndrome on mental health is well known, with psychiatric symptoms frequently persisting following remission of Cushing’s syndrome. But do all psychiatric symptoms similarly remain, and over what period? This Publication Highlight describes the work of Bengtsson D, et al. whose findings emphasize both the need for early diagnosis of Cushing’s syndrome and continual mental health monitoring.

The use of radiotherapy in the treatment of pituitary adenoma or craniopharyngioma is associated with risk of second brain tumour, although its quantitative assessment has traditionally been hampered by methodological limitations. This Publication Highlight describes the work of Hamblin R, et al. whose retrospective cohort study helps clarify the risks associated with irradiation.

The European Reference Network on Rare Endocrine Conditions surveyed the prevention of venous thromboembolism in Cushing’s syndrome patients in European reference centers. Read the Publication Highlight to see the results reported by van Haalen et al. on behalf of the Endo-ERN Cushing and Thrombosis Study Group.

This retrospective cohort study from four European referral centres examined data from the patient records of individuals with ectopic Cushing’s syndrome induced by medullary thyroid cancer. Read the Publication Highlight to see what Koehler et al. and the German Study Group for Rare Malignant Tumours of the Thyroid and Parathyroid Glands discovered.

GIP-dependent primary bilateral macronodular adrenal hyperplasia with Cushing’s syndrome is caused by aberrant expression of the GIP receptor in adrenal lesions. This multicentre, retrospective, cohort study at endocrine hospitals and university hospitals in France, Canada, Italy, Greece, Belgium, and the Netherlands aims to identify the underlying genetic driver event.

Although bilateral adrenalectomy has been extensively used to treat patients with overt CS, studies have shown the benefit of unilateral adrenalectomy for the management of some tumor subtypes. This Publication Highlight examines the role of unilateral adrenalectomy in the management of primary bilateral macronodular adrenocortical hyperplasia, a rare form of pituitary ACTH-independent Cushing’s syndrome.

Steroidogenesis inhibitors are recommended when surgery has failed or is otherwise inappropriate, when it has been refused by the patient, or while waiting for maximal radiation therapy to take effect. Several factors must be considered when initiating and maintaining steroidogenesis inhibition – this summary offers an example of the ‘titrate to normalization’ approach to therapy and compares the latter with ‘block and replace’, covering patient selection, ‘how’, monitoring and side effects.

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.