Endocrine Abstracts

Objective: To evaluate the outcome of preoperative therapy with ketoconazole (KTZ) and/or metyrapone (MTP), in previously untreated CS patients who later underwent surgery.

Design and methods: A total of 62 CS patients (85% ACTH-dependent), who have been treated with steroidogenesis inhibitors prior to surgery in our centre between 1983 and 2010, were retrospectively studied. T0 and t1 defined visit at baseline and at the end of medical treatment, respectively.

Results: Outcomes were classified into the following three groups based upon clinical and biochemical (normal UFC) control of hypercortisolism at t1: group CO (controlled) included 20 patients (32%) with eucortisolism and significant clinical improvement as compared with t0; group NC (not controlled) included 30 patients (48%) who had persistent hypercortisolism and lack of clinical control of CS symptoms; and group PC (partially controlled) included 12 patients (19%) who presented eucortisolism but no real clinical improvement. Median duration of treatment was 4 months (range: 1–30.7 months), median cumulative dose of KTZ and MTP was 57g (range: 3.6-240 g) and 120g (range: 7.5–1215g), respectively. No differences in baseline characteristics were observed between groups. Systolic blood pressure at t1 was significantly higher in PC than in NC patients (P<0.05). Hypertension persisted more frequently in PC patients than in the other groups (P<0.05) after a median post-surgery follow-up of 93 months (range: 2–276 months). UFC at t0 (r=0.458; P<0.0001) and NC status (r=−0.315; P<0.0001) predicted the decline in UFC during medical treatment, and remained significant after correcting for baseline characteristics, type and dose of the medications (R2, 0.770).

Conclusions: Preoperative administration of KTZ, MTP or both normalised UFC in 52% of CS patients, although concomitant clinical improvement was not reached in all cases. Future studies are needed to categorise the response to medical therapy and to individualise the treatment in CS patients.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.