ECE2018 Poster Presentations: Adrenal and Neuroendocrine Tumours Adrenal cortex (to include Cushing's) (70 abstracts)
Preoperative treatment with metyrapone in patient with Cushing’s syndrome due to adrenal adenoma: a pilot prospective study
Soraya Puglisi 1 , Paola Perotti 1 , Mattia Barbot 2 , Paolo Cosio 1 , Carla Scaroni 2 , Antonio Stigliano 3 , Pina Lardo 3 , Valentina Morelli 4 , Elisa Polledri 5 , Iacopo Chiodini 4 , Giuseppe Reimondo 1 , Anna Pia 1 & Massimo Terzolo 1
1Internal Medicine, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy; 2Endocrinology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy; 3Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome, Roma, Italy; 4Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy; 5Laboratory of Toxicology, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy.
Background and objectives: Metyrapone has been approved for the treatment of patients with Cushing’s syndrome from all causes, but only few retrospective clinical studies are available. The aim of our study was the prospective assessment of metyrapone as pre-operative treatment.
Methods: Before adrenalectomy, 7 patients with ACTH-independent Cushing’s syndrome due to adrenal adenoma were prospectively treated with metyrapone for 3 months, with endocrine work-up and clinical evaluation at screening and at predefined evaluation time points (Day 14, 31, 48, 65, 82).
Results: In all patients, UFC levels decreased up to normal range from baseline to Day 82 [609 (188–1476) vs. 69 (28–152) nmol/24 h, P<0.02], with a reduction of serum and salivary cortisol levels, and no significant increase of plasma ACTH and serum DHEAS levels. Clinical improvement was reported on quality of life [+16.7 (+4.2;+52.00) points, p <0.04) and pressure control [systolic pressure, −25 (−52;−10) mmHg, P<0.01; diastolic pressure, −16 (−50;+2 mmHg), P<0.03)]. No significant change in weight, electrolytes, glycemic and lipid profile was reported. Although in women a significant increase of testosterone and androstenedione was reported, no worsening of clinical hyperandrogenism was observed. All drug-related adverse events (nausea, fatigue, low grade fever, edema of lower limbs and facial rash) were grade 1 or 2 and generally transient.
Conclusions: This prospective pilot study demonstrated that metyrapone is effective in normalizing biochemical and clinical parameters in patients with Cushing’s syndrome due to adrenal adenoma before surgical intervention, with minimal side effects.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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