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Horm Metab Res 2018; 50(04): 280-289
DOI: 10.1055/a-0580-0460
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Cushing’s Syndrome: A Historic Review of the Treatment Strategies and Corresponding Outcomes in a Single Tertiary Center over the Past Half-Century

Anelia Nankova
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Maria Yaneva
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
2   Centre Hospitalier du Nord, Ettelbruck, Luxembourg
,
Atanaska Elenkova
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Dimitar Tcharaktchiev
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Marin Marinov
3   Department of Neurosurgery, University Hospital “St. Ivan Rilski”, Medical University, Sofia, Bulgaria
,
Asen Hadzhiyanev
3   Department of Neurosurgery, University Hospital “St. Ivan Rilski”, Medical University, Sofia, Bulgaria
,
Tanyo Sechanov
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Georgi Gantchev
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Georgi Todorov
4   Department of Surgery, Medical University of Sofia, Alexandrovska University Hospital, Sofia, Bulgaria
,
Georgi Kirilov
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Krasimir Kalinov
5   New Bulgarian University, Sofia, Bulgaria
,
Maria Andreeva
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
,
Sabina Zacharieva
1   Clinical Center of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
› Author Affiliations
Further Information

Publication History

received 07 November 2017

accepted 13 February 2018

Publication Date:
05 April 2018 (online)

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Abstract

Cushing’s syndrome (CS) is associated with serious comorbidities and an increased mortality rate that could be reduced only if strict biochemical control is achieved. The aim of this study was to show the 50-year experience of a single tertiary center in the management of CS patients – the different treatment modalities used over the years and the corresponding outcomes. It was a retrospective study of a large cohort of patients from the Bulgarian CS database: 613 patients (374 with ACTH-dependent and 239 with ACTH-independent CS). Pituitary surgery was applied to 242 patients with Cushing’s disease (CD) with initial remission rate of 74% of which 10% relapsed. Approximately 36% manifested with active disease during the long-term follow-up (26% with persistent disease, 10% relapses) most of which were subjected to a secondary treatment (13.6% to pituitary resurgery, 14% to pituitary radiotherapy, and 5.4% to bilateral adrenalectomy). A total of 294 CD patients received medical therapy with overall remission rates for the most commonly used drugs: dopamine agonists 20%, pasireotide 30%, and ketoconazole 63%. Significant improvement of results was achieved by combining drugs with different mechanisms of action. Regardless of the progress in the neurosurgery and radiotherapy techniques and new drugs discovery, the management of patients with CS remains a real challenge for physicians. Not only patients with adrenal carcinoma but also significant percentage of subjects with persistent and recurrent Cushing’s disease often require a polymodal approach and the efforts of a multidisciplinary highly qualified, experienced, and motivated team in order to achieve a long-term remission.

Key words

Cushing’s disease - pituitary surgery - adrenalectomy - adrenal carcinoma
 

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