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Horm Metab Res 2013; 45(02): 109-117
DOI: 10.1055/s-0032-1330009
Review
© Georg Thieme Verlag KG Stuttgart · New York

The Therapy of Cushing’s Disease in Adults and Children: An Update

A. Juszczak
1   Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
,
M. E. Ertorer
2   Faculty of Medicine, Adana Teaching and Research Centre – Endocrinology and Metabolism, Baskent University, Adana, Turkey
,
A. Grossman
1   Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
› Institutsangaben
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Publikationsverlauf

received 17. Juli 2012

accepted 22. Oktober 2012

Publikationsdatum:
07. Dezember 2012 (online)

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Abstract

Cushing’s disease (CD) is a rare endocrine disorder resulting from excessive production of adrenocorticotrophin hormone by a pituitary adenoma. The consequent hypercortisolaemia gives rise to characteristic features of the disease and its morbidities. Treatments aim to restore normal cortisol levels, provide long-term control of the disease and the tumour, and the improvement of patient well-being. The first line of treatment remains transsphenoidal surgery with remission rates of 65–90% in CD secondary to a pituitary microadenoma. Second-line treatment includes repeat surgery, radiotherapy, medical therapy, and bilateral adrenalectomy. The success rate of radiotherapy ranges from 46% to 74% and is probably independent of the mode of delivery of the radiation, but may take several years to become effective. Medical therapy is useful in acutely unwell patients or while awaiting radiotherapy to become effective. The most often-used medical agents include metyrapone and ketoconazole, which inhibit steroidogenesis; less often, centrally-acting drugs or a glucocorticoid receptor blocker are used, but experience with them is more limited. Bilateral adrenalectomy remains an important treatment option to control unresponsive severe hypercortisolism, particularly in patients with severe CD.

The management of childhood CD does not differ from adult disease, with transsphenoidal surgery as successful as in adults but radiotherapy is more rapid in onset. Regardless of the age of the patient, Cushing’s disease remains a challenge to the physician and requires a multidisciplinary approach to achieve the most desirable outcome.

Key words

hypercortisolism - ACTH - HPA axis
 

  • References

  • 1 Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet 2006; 367: 1605-1617
    CrossrefPubMedGoogle Scholar
  • 2 Juszczak A, Grossman A. The investigation of cushing syndrome: essentials in optimizing appropriate diagnosis and management. Ann Saudi Med 2012; 32: 455-461
    PubMedGoogle Scholar
  • 3 Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A, Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M. Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2008; 93: 2454-2462
    CrossrefPubMedGoogle Scholar
  • 4 Kaltsas GA, Giannulis MG, Newell-Price JD, Dacie JE, Thakkar C, Afshar F, Monson JP, Grossman AB, Besser GM, Trainer PJ. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 1999; 84: 487-492
    CrossrefPubMedGoogle Scholar
  • 5 Sahdev A, Reznek RH, Evanson J, Grossman AB. Imaging in Cushing’s syndrome. Arq Bras Endocrinol Metabol 2007; 51: 1319-1328
    CrossrefPubMedGoogle Scholar
  • 6 Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB, Savage MO, Afshar F, Besser GM. Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol (Oxf) 1993; 38: 73-78
    CrossrefPubMedGoogle Scholar
  • 7 Valassi E, Biller BM, Swearingen B, Pecori Giraldi F, Losa M, Mortini P, Hayden D, Cavagnini F, Klibanski A. Delayed remission after transsphenoidal surgery in patients with Cushing’s disease. J Clin Endocrinol Metab 2010; 95: 601-610
    CrossrefPubMedGoogle Scholar
  • 8 Hassan-Smith ZK, Sherlock M, Reulen RC, Arlt W, Ayuk J, Toogood AA, Cooper MS, Johnson AP, Stewart PM. Outcome of Cushing’s disease following transsphenoidal surgery in a single center over 20 years. J Clin Endocrinol Metab 2012; 97: 1194-1201
    CrossrefPubMedGoogle Scholar
  • 9 Hofmann BM, Fahlbusch R. Treatment of Cushing’s disease: a retrospective clinical study of the latest 100 cases. Front Horm Res 2006; 34: 158-184
    PubMedGoogle Scholar
  • 10 Storr HL, Alexandraki KI, Martin L, Isidori AM, Kaltsas GA, Monson JP, Besser GM, Matson M, Evanson J, Afshar F, Sabin I, Savage MO, Grossman AB. Comparisons in the epidemiology, diagnostic features and cure rate by transsphenoidal surgery between paediatric and adult-onset Cushing’s disease. Eur J Endocrinol 2011; 164: 667-674
    CrossrefPubMedGoogle Scholar
  • 11 Atkinson AB, Kennedy A, Wiggam MI, McCance DR, Sheridan B. Long-term remission rates after pituitary surgery for Cushing’s disease: the need for long-term surveillance. Clin Endocrinol (Oxf) 2005; 63: 549-559
    CrossrefPubMedGoogle Scholar
  • 12 Swearingen B, Biller BM, Barker 2nd FG, Katznelson L, Grinspoon S, Klibanski A, Zervas NT. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 1999; 130: 821-824
    CrossrefPubMedGoogle Scholar
  • 13 Blevins Jr LS, Christy JH, Khajavi M, Tindall GT. Outcomes of therapy for Cushing’s disease due to adrenocorticotropin-secreting pituitary macroadenomas. J Clin Endocrinol Metab 1998; 83: 63-67
    CrossrefPubMedGoogle Scholar
  • 14 Benveniste RJ, King WA, Walsh J, Lee JS, Delman BN, Post KD. Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma. J Neurosurg 2005; 102: 1004-1012
    CrossrefPubMedGoogle Scholar
  • 15 Hofmann BM, Hlavac M, Kreutzer J, Grabenbauer G, Fahlbusch R. Surgical treatment of recurrent Cushing’s disease. Neurosurgery. 2006; 58: 1108-1118 discussion 1108–1118
    PubMedGoogle Scholar
  • 16 Minniti G, Brada M. Radiotherapy and radiosurgery for Cushing’s disease. Arq Bras Endocrinol Metabol 2007; 51: 1373-1380
    CrossrefPubMedGoogle Scholar
  • 17 Leber KA, Bergloff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 1998; 88: 43-50
    CrossrefPubMedGoogle Scholar
  • 18 Minniti G, Osti M, Jaffrain-Rea ML, Esposito V, Cantore G, Maurizi Enrici R. Long term follow-up results of postoperative radiation therapy for Cushing’s disease. J Neurooncol 2007; 84: 79-84
    CrossrefPubMedGoogle Scholar
  • 19 Estrada J, Boronat M, Mielgo M, Magallon R, Millan I, Diez S, Lucas T, Barcelo B. The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing’s disease. N Engl J Med 1997; 336: 172-177
    CrossrefPubMedGoogle Scholar
  • 20 Castinetti F, Nagai M, Dufour H, Kuhn JM, Morange I, Jaquet P, Conte-Devolx B, Regis J, Brue T. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing’s disease. Eur J Endocrinol 2007; 156: 91-98
    CrossrefPubMedGoogle Scholar
  • 21 Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma Knife surgery for Cushing’s disease. J Neurosurg 2007; 106: 980-987
    CrossrefPubMedGoogle Scholar
  • 22 Gil-Cardenas A, Herrera MF, Diaz-Polanco A, Rios JM, Pantoja JP. Nelson’s syndrome after bilateral adrenalectomy for Cushing’s disease. Surgery. 2007; 141: 147-151 discussion 142– 151
    PubMedGoogle Scholar
  • 23 Jenkins PJ, Trainer PJ, Plowman PN, Shand WS, Grossman AB, Wass JA, Besser GM. The long-term outcome after adrenalectomy and prophylactic pituitary radiotherapy in adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 1995; 80: 165-171
    CrossrefPubMedGoogle Scholar
  • 24 Grossman AB. Clinical Review: The diagnosis and management of central hypoadrenalism. J Clin Endocrinol Metab 2010; 95: 4855-4863
    CrossrefPubMedGoogle Scholar
  • 25 Barber TM, Adams E, Ansorge O, Byrne JV, Karavitaki N, Wass JA. Nelson’s syndrome. Eur J Endocrinol 2010; 163: 495-507
    CrossrefPubMedGoogle Scholar
  • 26 Assie G, Bahurel H, Coste J, Silvera S, Kujas M, Dugue MA, Karray F, Dousset B, Bertherat J, Legmann P, Bertagna X. Corticotroph tumor progression after adrenalectomy in Cushing’s Disease: A reappraisal of Nelson’s Syndrome. J Clin Endocrinol Metab 2007; 92: 172-179
    CrossrefPubMedGoogle Scholar
  • 27 Verhelst JA, Trainer PJ, Howlett TA, Perry L, Rees LH, Grossman AB, Wass JA, Besser GM. Short and long-term responses to metyrapone in the medical management of 91 patients with Cushing’s syndrome. Clin Endocrinol (Oxf) 1991; 35: 169-178
    CrossrefPubMedGoogle Scholar
  • 28 Praw SS, Heaney AP. Medical treatment of Cushing’s disease: Overview and recent findings. Int J Gen Med 2009; 2: 209-217
    PubMedGoogle Scholar
  • 29 Castinetti F, Morange I, Jaquet P, Conte-Devolx B, Brue T. Ketoconazole revisited: a preoperative or postoperative treatment in Cushing’s disease. Eur J Endocrinol 2008; 158: 91-99
    CrossrefPubMedGoogle Scholar
  • 30 Sonino N, Boscaro M, Paoletta A, Mantero F, Ziliotto D. Ketoconazole treatment in Cushing’s syndrome: experience in 34 patients. Clin Endocrinol (Oxf) 1991; 35: 347-352
    CrossrefPubMedGoogle Scholar
  • 31 Alexandraki KI, Kaltsas GA, le Roux CW, Fassnacht M, Ajodha S, Christ-Crain M, Akker SA, Drake WM, Edwards R, Allolio B, Grossman AB. Assessment of serum-free cortisol levels in patients with adrenocortical carcinoma treated with mitotane: a pilot study. Clin Endocrinol (Oxf) 2010; 72: 305-311
    CrossrefPubMedGoogle Scholar
  • 32 Terzolo M, Pia A, Berruti A, Osella G, Ali A, Carbone V, Testa E, Dogliotti L, Angeli A. Low-dose monitored mitotane treatment achieves the therapeutic range with manageable side effects in patients with adrenocortical cancer. J Clin Endocrinol Metab 2000; 85: 2234-2238
    CrossrefPubMedGoogle Scholar
  • 33 Dang CN, Trainer P. Pharmacological management of Cushing’s syndrome: an update. Arq Bras Endocrinol Metabol 2007; 51: 1339-1348
    CrossrefPubMedGoogle Scholar
  • 34 Kamenicky P, Droumaguet C, Salenave S, Blanchard A, Jublanc C, Gautier JF, Brailly-Tabard S, Leboulleux S, Schlumberger M, Baudin E, Chanson P, Young J. Mitotane, metyrapone, and ketoconazole combination therapy as an alternative to rescue adrenalectomy for severe ACTH-dependent Cushing’s syndrome. J Clin Endocrinol Metab 2011; 96: 2796-2804
    CrossrefPubMedGoogle Scholar
  • 35 Schulte HM, Benker G, Reinwein D, Sippell WG, Allolio B. Infusion of low dose etomidate: correction of hypercortisolemia in patients with Cushing’s syndrome and dose response relationship in normal subjects. J Clin Endocrinol Metab 1990; 70: 1426-1430
    CrossrefPubMedGoogle Scholar
  • 36 Preda VA, Sen J, Karavitaki N, Grossman A. Etomidate in the Management of Hypercortisolaemia in Cushing’s Syndrome. Eur J Endocrinol 2012; 167: 137-143
    CrossrefPubMedGoogle Scholar
  • 37 Fleseriu M, Biller BM, Findling JW, Molitch ME, Schteingart DE, Gross C. Mifepristone, a Glucocorticoid Receptor Antagonist, Produces Clinical and Metabolic Benefits in Patients with Cushing’s Syndrome. J Clin Endocrinol Metab 2012; 97: 2039-2049
    CrossrefPubMedGoogle Scholar
  • 38 Castinetti F, Conte-Devolx B, Brue T. Medical treatment of Cushing’s syndrome: glucocorticoid receptor antagonists and mifepristone. Neuroendocrinology 2010; 92 (Suppl. 01) 125-130
    CrossrefPubMedGoogle Scholar
  • 39 Pivonello R, Ferone D, de Herder WW, Kros JM, De Caro ML, Arvigo M, Annunziato L, Lombardi G, Colao A, Hofland LJ, Lamberts SW. Dopamine receptor expression and function in corticotroph pituitary tumors. J Clin Endocrinol Metab 2004; 89: 2452-2462
    CrossrefPubMedGoogle Scholar
  • 40 Miller JW, Crapo L. The medical treatment of Cushing’s syndrome. Endocr Rev 1993; 14: 443-458
    CrossrefPubMedGoogle Scholar
  • 41 Vilar L, Naves LA, Azevedo MF, Arruda MJ, Arahata CM, Moura ESL, Agra R, Pontes L, Montenegro L, Albuquerque JL, Canadas V. Effectiveness of cabergoline in monotherapy and combined with ketoconazole in the management of Cushing’s disease. Pituitary 2010; 13: 123-129
    CrossrefPubMedGoogle Scholar
  • 42 Boscaro M, Ludlam WH, Atkinson B, Glusman JE, Petersenn S, Reincke M, Snyder P, Tabarin A, Biller BM, Findling J, Melmed S, Darby CH, Hu K, Wang Y, Freda PU, Grossman AB, Frohman LA, Bertherat J. Treatment of pituitary-dependent Cushing’s disease with the multireceptor ligand somatostatin analog pasireotide (SOM230): a multicenter, phase II trial. J Clin Endocrinol Metab 2009; 94: 115-122
    CrossrefPubMedGoogle Scholar
  • 43 Colao A, Petersenn S, Newell-Price J, Findling JW, Gu F, Maldonado M, Schoenherr U, Mills D, Salgado LR, Biller BM. A 12-month phase 3 study of pasireotide in Cushing’s disease. N Engl J Med 2012; 366: 914-924
    CrossrefPubMedGoogle Scholar
  • 44 Pecori Giraldi F, Scaroni C, Arvat E, Martin M, Giordano R, Albiger N, Leao AA, Picu A, Mantero F, Cavagnini F. Effect of protracted treatment with rosiglitazone, a PPARgamma agonist, in patients with Cushing’s disease. Clin Endocrinol (Oxf) 2006; 64: 219-224
    CrossrefPubMedGoogle Scholar
  • 45 Suri D, Weiss RE. Effect of pioglitazone on adrenocorticotropic hormone and cortisol secretion in Cushing’s disease. J Clin Endocrinol Metab 2005; 90: 1340-1346
    PubMedGoogle Scholar
  • 46 Storr HL, Isidori AM, Monson JP, Besser GM, Grossman AB, Savage MO. Prepubertal Cushing’s disease is more common in males, but there is no increase in severity at diagnosis. J Clin Endocrinol Metab 2004; 89: 3818-3820
    CrossrefPubMedGoogle Scholar
  • 47 Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler Jr GB, Nieman LK, Chrousos GP. Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 1994; 331: 629-636
    CrossrefPubMedGoogle Scholar
  • 48 Dupuis CC, Storr HL, Perry LA, Ho JT, Ahmed L, Ong KK, Dunger DB, Monson JP, Grossman AB, Besser GM, Savage MO. Abnormal puberty in paediatric Cushing’s disease: relationship with adrenal androgen, sex hormone binding globulin and gonadotrophin concentrations. Clin Endocrinol (Oxf). 2007 66. 838-843
    PubMedGoogle Scholar
  • 49 Newell-Price J, Trainer P, Besser M, Grossman A. The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing’s states. Endocr Rev 1998; 19: 647-672
    CrossrefPubMedGoogle Scholar
  • 50 Devoe DJ, Miller WL, Conte FA, Kaplan SL, Grumbach MM, Rosenthal SM, Wilson CB, Gitelman SE. Long-term outcome in children and adolescents after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 1997; 82: 3196-3202
    CrossrefPubMedGoogle Scholar
  • 51 Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA. Treatment of Cushing’s disease in childhood and adolescence by transsphenoidal microadenomectomy. N Engl J Med 1984; 310: 889-893
    CrossrefPubMedGoogle Scholar
  • 52 Weber A, Trainer PJ, Grossman AB, Afshar F, Medbak S, Perry LA, Plowman PN, Rees LH, Besser GM, Savage MO. Investigation, management and therapeutic outcome in 12 cases of childhood and adolescent Cushing’s syndrome. Clin Endocrinol (Oxf) 1995; 43: 19-28
    CrossrefPubMedGoogle Scholar
  • 53 Oliveira RS, Castro M, Antonini SR, Martinelli Jr CE, Moreira AC, Machado HR. Surgical management of pediatric Cushing’s disease: an analysis of 15 consecutive cases at a specialized neurosurgical center. Arq Bras Endocrinol Metabol 2010; 54: 17-23
    CrossrefPubMedGoogle Scholar
  • 54 Buchfelder M, Fahlbusch R. Neurosurgical treatment of Cushing’s disease in children and adolescents. Acta Neurochir Suppl (Wien) 1985; 35: 101-105
    PubMedGoogle Scholar
  • 55 Batista D, Courkoutsakis NA, Oldfield EH, Griffin KJ, Keil M, Patronas NJ, Stratakis CA. Detection of adrenocorticotropin-secreting pituitary adenomas by magnetic resonance imaging in children and adolescents with cushing disease. J Clin Endocrinol Metab 2005; 90: 5134-5140
    CrossrefPubMedGoogle Scholar
  • 56 Dias RP, Kumaran A, Chan LF, Martin L, Afshar F, Matson M, Plowman PN, Monson JP, Besser GM, Grossman AB, Savage MO, Storr HL. Diagnosis, management and therapeutic outcome in prepubertal Cushing’s disease. Eur J Endocrinol 2010; 162: 603-609
    CrossrefPubMedGoogle Scholar
  • 57 Lienhardt A, Grossman AB, Dacie JE, Evanson J, Huebner A, Afshar F, Plowman PN, Besser GM, Savage MO. Relative contributions of inferior petrosal sinus sampling and pituitary imaging in the investigation of children and adolescents with ACTH dependent Cushing’s syndrome. J Clin Endocrinol Metab 2001; 86: 5711-5714
    CrossrefPubMedGoogle Scholar
  • 58 Batista D, Gennari M, Riar J, Chang R, Keil MF, Oldfield EH, Stratakis CA. An assessment of petrosal sinus sampling for localization of pituitary microadenomas in children with Cushing disease. J Clin Endocrinol Metab 2006; 91: 221-224
    CrossrefPubMedGoogle Scholar
  • 59 Storr HL, Afshar F, Matson M, Sabin I, Davies KM, Evanson J, Plowman PN, Besser GM, Monson JP, Grossman AB, Savage MO. Factors influencing cure by transsphenoidal selective adenomectomy in paediatric Cushing’s disease. Eur J Endocrinol 2005; 152: 825-833
    CrossrefPubMedGoogle Scholar
  • 60 Joshi SM, Hewitt RJ, Storr HL, Rezajooi K, Ellamushi H, Grossman AB, Savage MO, Afshar F.. Cushing’s disease in children and adolescents: 20 years of experience in a single neurosurgical center. Neurosurgery. 2005; 57: 281-285 discussion 281–285
    PubMedGoogle Scholar
  • 61 Leinung MC, Kane LA, Scheithauer BW, Carpenter PC, Laws Jr ER, Zimmerman D. Long term follow-up of transsphenoidal surgery for the treatment of Cushing’s disease in childhood. J Clin Endocrinol Metab 1995; 80: 2475-2479
    CrossrefPubMedGoogle Scholar
  • 62 Storr HL, Plowman PN, Carroll PV, Francois I, Krassas GE, Afshar F, Besser GM, Grossman AB, Savage MO. Clinical and endocrine responses to pituitary radiotherapy in pediatric Cushing’s disease: an effective second-line treatment. J Clin Endocrinol Metab 2003; 88: 34-37
    CrossrefPubMedGoogle Scholar
  • 63 Lodish M, Dunn SV, Sinaii N, Keil MF, Stratakis CA. Recovery of the hypothalamic pituitary-adrenal axis in children and adolescents after surgical cure of Cushing’s disease. J Clin Endocrinol Metab 2012; 97: 1483-1491
    CrossrefPubMedGoogle Scholar
  • 64 Batista DL, Oldfield EH, Keil MF, Stratakis CA. Postoperative testing to predict recurrent Cushing’s disease in children. J Clin Endocrinol Metab 2009; 94: 2757-2765
    CrossrefPubMedGoogle Scholar
  • 65 McCance DR, Russell CF, Kennedy TL, Hadden DR, Kennedy L, Atkinson AB. Bilateral adrenalectomy: low mortality and morbidity in Cushing’s disease. Clin Endocrinol (Oxf) 1993; 39: 315-321
    CrossrefPubMedGoogle Scholar
  • 66 Lebrethon MC, Grossman AB, Afshar F, Plowman PN, Besser GM, Savage MO. Linear growth and final height after treatment for Cushing’s disease in childhood. J Clin Endocrinol Metab 2000; 85: 3262-3265
    CrossrefPubMedGoogle Scholar
  • 67 Greening JE, Brain CE, Perry LA, Mushtaq I, Sales Marques J, Grossman AB, Savage MO. Efficient short-term control of hypercortisolaemia by low-dose etomidate in severe paediatric Cushing’s disease. Horm Res 2005; 64: 140-143
    CrossrefPubMedGoogle Scholar
  • 68 Chan LF, Vaidya M, Westphal B, Allgrove J, Martin L, Afshar F, Hindmarsh PC, Savage MO, Grossman AB, Storr HL. Use of intravenous etomidate to control acute psychosis induced by the hypercortisolaemia in severe paediatric Cushing’s disease. Horm Res Paediatr 2011; 75: 441-446
    CrossrefPubMedGoogle Scholar
  • 69 Knappe UJ, Ludecke DK. Transnasal microsurgery in children and adolescents with Cushing’s disease. Neurosurgery. 1996; 39: 484-492 discussion 483–492
    PubMedGoogle Scholar
  • 70 Chan LF, Storr HL, Plowman PN, Perry LA, Besser GM, Grossman AB, Savage MO. Long-term anterior pituitary function in patients with paediatric Cushing’s disease treated with pituitary radiotherapy. Eur J Endocrinol 2007; 156: 477-482
    CrossrefPubMedGoogle Scholar
  • 71 Nicholl RM, Kirk JM, Grossman AB, Plowman PN, Besser GM, Savage MO. Acceleration of pubertal development following pituitary radiotherapy for Cushing’s disease. Clin Oncol (R Coll Radiol) 1993; 5: 393-394
    CrossrefPubMedGoogle Scholar
  • 72 Magiakou MA, Mastorakos G, Chrousos GP. Final stature in patients with endogenous Cushing’s syndrome. J Clin Endocrinol Metab 1994; 79: 1082-1085
    CrossrefPubMedGoogle Scholar
  • 73 Johnston LB, Grossmann AB, Plowman PN, Besser GM, Savage MO. Normal final height and apparent cure after pituitary irradiation for Cushing’s disease in childhood: long-term follow-up of anterior pituitary function. Clin Endocrinol (Oxf) 1998; 48: 663-667
    CrossrefPubMedGoogle Scholar
  • 74 Davies JH, Storr HL, Davies K, Monson JP, Besser GM, Afshar F, Plowman PN, Grossman A, Savage MO. Final adult height and body mass index after cure of paediatric Cushing’s disease. Clin Endocrinol (Oxf) 2005; 62: 466-472
    CrossrefPubMedGoogle Scholar