Valassi E, et al. - This study was performed to assess how frequently preoperative medical treatment (PMT) was given to Cushing's syndrome (CS) patients across Europe and to investigate differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery. In addition, the physicians determined if PMT influenced the postoperative outcome in pituitary-dependent CS (PIT-CS). In contrast with adrenal-dependent CS (ADR-CS), CS from an ectopic source (ECT-CS) and PIT-CS exhibited greater likelihood of receiving PMT. Data reported more severe clinical features at the diagnosis and poorer quality of life in PIT-CS patients treated with PMT. The interpretation of immediate postoperative outcome could be confounded with PMT. They recommended follow-up to definitely evaluate surgical results.

Methods

• A total of 1,143 CS patients entered into the ERCUSYN database from 57 centres in 26 countries.
• During this study, 69% patients presented with PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS), and 1% were classified as having CS from other causes (OTH-CS).

Results

• In this study, 20% of patients took PMT.
• PMT was offered more frequently in ECT-CS and PIT-CS compared to ADR-CS (p < 0.001).
• Ketoconazole (62%), metyrapone (16%), and a combination of both (12%) were the most commonly used drugs.
• The median (interquartile range) duration of PMT was 109 (98) days.
• More severe clinical features at diagnosis and poorer quality of life were noted in PIT-CS patients treated with PMT compared to those undergoing primary surgery (SX) (p < 0.05).
• PIT-CS patients treated with PMT were more likely to have normal cortisol (p < 0.01) and a lower remission rate (p < 0.01) within 7 days of surgery.
• Between SX and PMT groups, no differences in morbidity or remission rates were observed within 6 months of surgery.