Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas.
CONTEXT: Cushing's disease as a result of a pituitary macroadenoma is an uncommon cause of Cushing's syndrome, and reports in the published literature are few and of limited size. OBJECTIVE: Our objective was to establish the clinical and biochemical characteristics of macroadenomas assoc...
| Asıl Yazarlar: | , , , , , , , , , |
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| Materyal Türü: | Journal article |
| Dil: | English |
| Baskı/Yayın Bilgisi: |
2005
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| _version_ | 1826266594734505984 |
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| author | Woo, Y Isidori, A Wat, W Kaltsas, G Afshar, F Sabin, I Jenkins, P Monson, J Besser, G Grossman, AB |
| author_facet | Woo, Y Isidori, A Wat, W Kaltsas, G Afshar, F Sabin, I Jenkins, P Monson, J Besser, G Grossman, AB |
| author_sort | Woo, Y |
| collection | OXFORD |
| description | CONTEXT: Cushing's disease as a result of a pituitary macroadenoma is an uncommon cause of Cushing's syndrome, and reports in the published literature are few and of limited size. OBJECTIVE: Our objective was to establish the clinical and biochemical characteristics of macroadenomas associated with Cushing's disease compared with a large cohort of microadenomas and to assess their response to therapy. DESIGN: We conducted a retrospective case-records study for the years 1964-2001. SETTING: The study occurred at a tertiary referral hospital center. PATIENTS: Patients had Cushing's disease presenting with a pituitary macroadenoma, in comparison with a large group of microadenoma patients. INTERVENTIONS: Interventions included therapy with surgery and radiotherapy. MAIN OUTCOME MEASURES: Outcome measures included basal and dynamically responsive plasma ACTH and cortisol levels and response to treatment. RESULTS: We identified 18 patients with Cushing's disease secondary to a macroadenoma; basal 0900 h plasma ACTH was 135.8 +/- 32.5 and 45.0 +/- 4.3 ng/liter (mean +/- SEM), respectively, in macroadenomas and microadenomas (P = 0.013). Mean 0900 h serum cortisol was significantly increased in the macroadenomas (27.5 +/- 3.0 microg/dl, 759.6 +/- 82.6 nmol/liter, vs. 22.6 +/- 0.6 microg/dl, 624.7 +/- 16.4 nmol/liter) (P = 0.021). Testing with high-dose dexamethasone showed less suppression in the macroadenomas (57.6 +/- 8.7% vs. 74.4 +/- 2.1%; P = 0.02) and an attenuated ACTH response to CRH. For all biochemical variables there was considerable overlap between the two groups. Few patients with macroadenomas were cured by surgery. CONCLUSIONS: Pituitary macroadenomas causing Cushing's disease have biochemical features largely distinct from patients harboring microadenomas but represent one end of a continuum. |
| first_indexed | 2024-03-06T20:41:19Z |
| format | Journal article |
| id | oxford-uuid:34640a25-e338-440b-b0df-0c1a3d691c20 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:41:19Z |
| publishDate | 2005 |
| record_format | dspace |
| spelling | oxford-uuid:34640a25-e338-440b-b0df-0c1a3d691c202022-03-26T13:25:40ZClinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:34640a25-e338-440b-b0df-0c1a3d691c20EnglishSymplectic Elements at Oxford2005Woo, YIsidori, AWat, WKaltsas, GAfshar, FSabin, IJenkins, PMonson, JBesser, GGrossman, AB CONTEXT: Cushing's disease as a result of a pituitary macroadenoma is an uncommon cause of Cushing's syndrome, and reports in the published literature are few and of limited size. OBJECTIVE: Our objective was to establish the clinical and biochemical characteristics of macroadenomas associated with Cushing's disease compared with a large cohort of microadenomas and to assess their response to therapy. DESIGN: We conducted a retrospective case-records study for the years 1964-2001. SETTING: The study occurred at a tertiary referral hospital center. PATIENTS: Patients had Cushing's disease presenting with a pituitary macroadenoma, in comparison with a large group of microadenoma patients. INTERVENTIONS: Interventions included therapy with surgery and radiotherapy. MAIN OUTCOME MEASURES: Outcome measures included basal and dynamically responsive plasma ACTH and cortisol levels and response to treatment. RESULTS: We identified 18 patients with Cushing's disease secondary to a macroadenoma; basal 0900 h plasma ACTH was 135.8 +/- 32.5 and 45.0 +/- 4.3 ng/liter (mean +/- SEM), respectively, in macroadenomas and microadenomas (P = 0.013). Mean 0900 h serum cortisol was significantly increased in the macroadenomas (27.5 +/- 3.0 microg/dl, 759.6 +/- 82.6 nmol/liter, vs. 22.6 +/- 0.6 microg/dl, 624.7 +/- 16.4 nmol/liter) (P = 0.021). Testing with high-dose dexamethasone showed less suppression in the macroadenomas (57.6 +/- 8.7% vs. 74.4 +/- 2.1%; P = 0.02) and an attenuated ACTH response to CRH. For all biochemical variables there was considerable overlap between the two groups. Few patients with macroadenomas were cured by surgery. CONCLUSIONS: Pituitary macroadenomas causing Cushing's disease have biochemical features largely distinct from patients harboring microadenomas but represent one end of a continuum. |
| spellingShingle | Woo, Y Isidori, A Wat, W Kaltsas, G Afshar, F Sabin, I Jenkins, P Monson, J Besser, G Grossman, AB Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. |
| title | Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. |
| title_full | Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. |
| title_fullStr | Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. |
| title_full_unstemmed | Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. |
| title_short | Clinical and biochemical characteristics of adrenocorticotropin-secreting macroadenomas. |
| title_sort | clinical and biochemical characteristics of adrenocorticotropin secreting macroadenomas |
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