Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations
Abstract Background While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatm...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | Clinical Diabetes and Endocrinology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40842-020-00105-4 |
| _version_ | 1818342314258464768 |
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| author | David R. Brown Honey E. East Bradley S. Eilerman Murray B. Gordon Elizabeth E. King Laura A. Knecht Brandon Salke Susan L. Samson Kevin C. J. Yuen Hanford Yau |
| author_facet | David R. Brown Honey E. East Bradley S. Eilerman Murray B. Gordon Elizabeth E. King Laura A. Knecht Brandon Salke Susan L. Samson Kevin C. J. Yuen Hanford Yau |
| author_sort | David R. Brown |
| collection | DOAJ |
| description | Abstract Background While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing Syndrome) trial. Mifepristone is a competitive glucocorticoid receptor antagonist and progesterone receptor antagonist that is associated with several treatment effects and adverse events that clinicians need to be aware of when considering its use. The objective of this review was to provide updated clinical management recommendations for patients with CS treated with mifepristone. Methods A panel of endocrinologists from the US with extensive experience in treating patients with CS, including with mifepristone, convened as part of a clinical advisory board to develop a consensus on the practical, real-world clinical management of patients on mifepristone. Results Comprehensive considerations and recommendations are provided for managing mifepristone-associated effects, including symptoms of cortisol withdrawal, hypokalemia, and change in thyroid function; effects related to its antiprogesterone activity; and rash. Additional management strategies to address concomitant medications and special clinical situations, such as surgery and use in specific populations, are also provided. Conclusion Safe and effective use of mifepristone requires clinical judgment and close patient monitoring to ensure optimal clinical outcomes. These consensus recommendations provide useful, practical guidance to clinicians using mifepristone. |
| first_indexed | 2024-12-13T16:12:43Z |
| format | Article |
| id | doaj.art-ad4fd882572a4b2fad421e4c884071c0 |
| institution | Directory Open Access Journal |
| issn | 2055-8260 |
| language | English |
| last_indexed | 2024-12-13T16:12:43Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Clinical Diabetes and Endocrinology |
| spelling | doaj.art-ad4fd882572a4b2fad421e4c884071c02022-12-21T23:38:54ZengBMCClinical Diabetes and Endocrinology2055-82602020-10-016111310.1186/s40842-020-00105-4Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendationsDavid R. Brown0Honey E. East1Bradley S. Eilerman2Murray B. Gordon3Elizabeth E. King4Laura A. Knecht5Brandon Salke6Susan L. Samson7Kevin C. J. Yuen8Hanford Yau9Private Practice, Endocrinology, Diabetes, and MetabolismMetabolic Medicine of MississippiRegional Diabetes Center, St. Elizabeth PhysiciansAllegheny Neuroendocrinology Center, Allegheny General HospitalEndocrine Associates of DallasMidtown Endocrine AssociatesOptime CarePituitary Center, Baylor St. Luke’s Medical Center, Baylor College of MedicineBarrow Neurological Institute and St. Joseph’s Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of MedicineDivision of Endocrinology, Diabetes, and Metabolism, The University of Central Florida College of MedicineAbstract Background While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing Syndrome) trial. Mifepristone is a competitive glucocorticoid receptor antagonist and progesterone receptor antagonist that is associated with several treatment effects and adverse events that clinicians need to be aware of when considering its use. The objective of this review was to provide updated clinical management recommendations for patients with CS treated with mifepristone. Methods A panel of endocrinologists from the US with extensive experience in treating patients with CS, including with mifepristone, convened as part of a clinical advisory board to develop a consensus on the practical, real-world clinical management of patients on mifepristone. Results Comprehensive considerations and recommendations are provided for managing mifepristone-associated effects, including symptoms of cortisol withdrawal, hypokalemia, and change in thyroid function; effects related to its antiprogesterone activity; and rash. Additional management strategies to address concomitant medications and special clinical situations, such as surgery and use in specific populations, are also provided. Conclusion Safe and effective use of mifepristone requires clinical judgment and close patient monitoring to ensure optimal clinical outcomes. These consensus recommendations provide useful, practical guidance to clinicians using mifepristone.http://link.springer.com/article/10.1186/s40842-020-00105-4Cushing syndromeDrug effectsEducation |
| spellingShingle | David R. Brown Honey E. East Bradley S. Eilerman Murray B. Gordon Elizabeth E. King Laura A. Knecht Brandon Salke Susan L. Samson Kevin C. J. Yuen Hanford Yau Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations Clinical Diabetes and Endocrinology Cushing syndrome Drug effects Education |
| title | Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations |
| title_full | Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations |
| title_fullStr | Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations |
| title_full_unstemmed | Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations |
| title_short | Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations |
| title_sort | clinical management of patients with cushing syndrome treated with mifepristone consensus recommendations |
| topic | Cushing syndrome Drug effects Education |
| url | http://link.springer.com/article/10.1186/s40842-020-00105-4 |
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