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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2022; 05(01): 021-028
DOI: 10.1055/s-0042-1755931
Original Article

Diagnosis and Management of Cushing's Disease: A Survey of Endocrinologists from the Middle East and North Africa

Salem A. Beshyah 
1   Department of Endocrinology, Yas Clinic Khalifa City, Abu Dhabi, United Arab Emirates
2   Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
,
Mussa H. Almalki
3   Obesity, Endocrine and Metabolism Centre, King Fahad Medical City, Riyadh, Saudi Arabia
4   Department of Medicine, College of Medicine, King Fahad Medical City, King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
,
Said Azzoug
5   Department of Endocrinology, Public Hospital Establishment, Ibn Ziri, Bologhine, Algiers, Algeria
,
Maya Barake 
6   Department of Endocrinology, Clemenceau Medical Center, Beirut, Lebanon
,
Khaled M. A. Al Dahmani
7   Department of Medicine, United Arab Emirates University, United Arab Emirates
8   Division of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
,
Melika Chihaoui
9   Department of Endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis-El Manar, Tunisia
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Abstract

Background Cushing's disease is the most prevalent cause of endogenous Cushing's syndrome. This study aimed to scope the current clinical practice pattern in managing Cushing's disease by endocrinologists in the Middle Eastern and North African (MENA) region.

Methods A questionnaire dealing with diagnosis, treatment, and follow-up of patients with Cushing's disease was adopted and sent electronically to a convenience sample of endocrinologists from the MENA region.

Results Out of 125 responses received, 88 were eligible for inclusion in the analysis. Most respondents selected the overnight dexamethasone suppression test (ONDST) and 24-hour urinary-free cortisol (UFC) as the best screening tests, 58 (66.7%) and 50 (57.5%) respectively, followed by midnight serum cortisol and midnight salivary cortisol. Measurement of serum adrenocorticotropic hormone (ACTH; 86.2%) and classic high-dose dexamethasone suppression test (40.2%) were selected for localization of the primary lesion. The primary choice of treatment was transsphenoidal pituitary surgery (98.8%). For the recurrence of Cushing's disease, medical therapy was the preferred modality followed by repeated pituitary surgery or bilateral adrenalectomy. In case of treatment failure following the first pituitary surgery and ketoconazole treatment, 36.9% selected pasireotide, while 32.1% chose bilateral adrenalectomy.

Conclusion ONDST and UFC are the two most common tests used to screen an index case with features of hypercortisolism. Pituitary surgery is the primary choice of treatment in Cushing's disease. However, medical treatment by ketoconazole is preferred for recurrent cases. Bilateral adrenalectomy is followed by pasireotide may be chosen in case of treatment failure after pituitary surgery and ketoconazole.

Keywords

clinical practice - Cushing's disease - diagnosis - management - MENA region

Authors' Contributions

All authors contributed to the conceptualization, design of the study, and the process of data collection; S.A.B., M.A.E., and K.M.A.D., were actively involved in interpretation of data and drafted the manuscript for all authors to critique and make relevant corrections. All the authors have read and agreed to final version of this manuscript.


Compliance with Ethical Principles

The study was conducted following the principles of the Declaration of Helsinki. The Institutional Review Board approved the study at Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. All participants provided informed consent before they could proceed to the survey questions.


Financial Support and Sponsorship

None.




Publication History

Article published online:
05 August 2022

© 2022. Gulf Association of Endocrinology and Diabetes (GAED). All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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