- |||||||||| A case of Papillary Craniopharyngioma WHO Grade 1 turned into Abscess (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_955;
PA associated with residual craniopharyngioma tissue is extremely rare and the exact pathophysiology is not well understood. If no evidence of sepsis or meningitis, treatment with transsphenoidal decompression and intravenous antibiotics has good clinical outcomes.
- |||||||||| dexamethasone / Generic mfg., cabergoline / Generic mfg.
Case of a large suprasellar-clival mass: Prolactinoma vs Paraganglioma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_953;
Admitted for urgent neurosurgery evaluation and high dose dexamethasone was initiated...A presumptive diagnosis of a giant prolactinoma was made for which cabergoline therapy was initiated...It has been named as the three P association, thought to be related to succinate dehydrogenase B and D mutations. Moreover, there are no cases in the literature of paragangliomas secreting prolactin.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Gonadotropin Secreting Pituitary Tumor Presenting as Primary Hypogonadism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_951;
The extremely low testosterone levels postoperatively suggest that his testicular function was mostly stimulated by the adenoma secreted FSH and was therefore drastically lost after surgery. This case increases awareness to consider a gonadotropin-secreting tumor in the differential diagnosis of a pituitary adenoma with high FSH or LH, even when testosterone level is unexpectedly low.
- |||||||||| dexamethasone / Generic mfg.
Severe Obesity in Cushing (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_912;
Overall, patients with CD and SO presented with longer disease duration, clinically less severe disease, and higher false-negative rates in UFC. Conventional screening for hypercortisolism in SO is not considered cost-effective, but patients with SO and unrecognized hypercortisolism have been submitted to bariatric surgery.
- |||||||||| dexamethasone / Generic mfg.
Evaluation of Combined CRH and HDDST Test Performance (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_908;
In cyclic CS, tests performed better in hypercortisolemic patients. The optimal response criteria were ?63% cortisol suppression for HDDST and ?39% ACTH or ?30% cortisol increase for the CRH test.
- |||||||||| Synjardy (empagliflozin/metformin) / Boehringer Ingelheim, Eli Lilly
Challenges in the Management of Extreme Hyperglycemia in an Acromegalic Patient (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_904;
Given the significant tumor mass effect, she was placed on dexamethasone 4 mg q12h...After successful surgical resection of the tumor, HbA1c decreased to 7.7% on 1.3 units/kg TDD of insulin, metformin and empagliflozin at eight weeks postoperatively.Clinical Lessons: Unusual presentations of rapidly increasing insulin requirements in newly diagnosed DM should raise clinical suspicion for secondary causes such as acromegaly...Given the need for semi-urgent surgery due to the tumor's mass effect, SSA therapy or GH-receptor antagonist was not initiated, and insulin therapy was the mainstay for preoperative glucose management. In severe cases of acromegaly-related hyperglycemia, subcutaneous insulin alone may not be sufficient for adequate glucose control, especially in the setting of preoperative steroids, and large doses of IV insulin may be needed to reach inpatient glucose goals.
- |||||||||| dexamethasone / Generic mfg., progesterone / Generic mfg.
Mysterious Resolution of Cushing's Disease (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_898;
Endocrine work-up included low dose 1mg dexamethasone suppression (LDST), total testosterone, FSH, LH, estradiol, sex hormone binding globulin, 17-hydroxyprogesterone, DHEA-sulfate, IGF-1, TSH, free T4, prolactin, and hemoglobin A1c...Interestingly, initial cortisol levels did not suggest remission, but later biochemical testing ruled out ongoing Cushing's disease. Due to inadequate tissue data, true etiology of disease and remission remains a mystery.
- |||||||||| Isturisa (osilodrostat) / Novartis, Recordati
Osilodrostat as an Emergency Alternative for Hypercortisolism in a Patient With an Impaired Liver Function. (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_896;
The mechanismof improvement of liver function may be indirect through decreasing the level ofhypercortisolemia, however potential direct beneficial influence of osilodrostat onliver function seems to be an interesting subject worth further investigation. Morestudies on the link between hypercortisolemia, liver function and steroidogenesisinhibitors are needed.
- |||||||||| Isturisa (osilodrostat) / Novartis, Recordati
Severe Hypercortisolemia- a Biological Time Bomb (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_894;
She had non-suppressed cortisol of 44.3 mcg/dL and ACTH of 113 pg/mL after overnight 8mg dexamethasone suppression test...IPSS with desmopressin stimulation showed IPSS to peripheral prolactin ratio was greater than 1.8 verifying successful catheterization...Her ACTH concentration gradient >1.4 between 2 sinuses lateralizing the lesion to the right.The patient was started on Osilodrostat 2mg bid for control of hypercortisolemia and subsequently treated with transsphenoidal resection of the pituitary adenoma...Severe hypercortisolemia is an endocrine emergency carrying high mortality. Expedited diagnoses, control of hypercortisolemia, anticoagulation and antibiotic prophylaxis can be life saving before definitive treatment can be done.
- |||||||||| ketoconazole / Generic mfg., hydrocortisone / Generic mfg.
Hiding in Plain Sight: Florid Cushing's Disease Presenting as a Severe Extremity Cellulitis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_893;
Following surgery, she developed transient adrenal insufficiency requiring hydrocortisone and she no longer required antihypertensives, insulin, or potassium therapy...Severe hypercortisolism was responsible for this patient's refractory infection, and if not controlled, she likely would have endured a lower extremity amputation. Rapid detection with elevated random serum and/or urine cortisol and treatment with a cortisol-lowering agent is critical and lifesaving.
- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg.
Unilateral Adrenal Hyperplasia Causing ACTH-Independent Hypercortisolism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_892;
This case report would be one of few describing the rare diagnosis of unilateral adrenal hyperplasia associated with ACTH-independent hypercortisolism and would add to the sparse literature currently available on this condition. Additionally, this case report highlights the clinical significance of mild autonomous cortisol secretion (MACS); despite only having an unsuppressed cortisol level following LDDS, this patient was found to have a suppressed HPA axis after unilateral adrenalectomy requiring corticosteroids.
- |||||||||| ketoconazole / Generic mfg., dexamethasone / Generic mfg.
A Rare Case of Ectopic Cushing's Syndrome Caused by Metastatic Parotid Gland Carcinoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_890;
This case highlights the importance of maintaining a high degree of suspicion for diagnosing ECS especially when patients present with rapid onset of signs and symptoms of Cushing's syndrome and a known underlying malignancy. Recognizing less common causes of ECS may prompt early diagnosis and intervention.
- |||||||||| dexamethasone / Generic mfg., desmopressin / Generic mfg.
Cushing's Disease Diagnosis Challenge with Standard Pituitary MRI: A Clinical Case Report (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_888;
In the case of equivocal 1.5 T MRI usually the next step is IPSS which is invasive. With availability of Corticotropin Releasing Hormone in the USA being difficult, limited studies of using DDAVP and limitations in finding tertiary centers to perform IPSS, a 3T MRI would be more feasible as a next step to identify a pituitary adenoma.
- |||||||||| cefazolin / Generic mfg., prednisone / Generic mfg., hydrocortisone / Generic mfg.
DRESS/DHIS-associated thyroiditis and hypophysitis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_856;
Review of medication charts identified the most likely causative agent as cefazolin...Biochemical abnormalities gradually normalized and his hydrocortisone ceased with symptomatic resolution.Endocrine involvement, particularly pancreas and thyroid has previously been reported in cases of DHIS/DRESS (3) (4). In this case, DHIS/DRESS-associated hypophysitis with thyroiditis may explain the clinical findings of pituitary dysfunction affecting multiple pituitary axes and the gradual recovery to normal pituitary function.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
Immunotherapy Induced Pituitary Apoplexy (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_853;
We present a case of a 42 year old male with past history of metastatic melanoma s/p 3 cycles of ipilimumab and nivolumab immunotherapy that originally was referred to endocrinology due to elevated prolactin of 40 and MRI finding of questionable 6 mm pituitary adenoma...Repeat hormonal testing showed persistent hormonal deficiencies with undetectable cortisol and ACTH despite holding hydrocortisone therapies...We hope this case helps bring awareness to the evolving list of conditions to survey for with immunotherapy and suggests a role of identifying prolactinomas biochemically and or radiographically to affect management. It may even suggest a role in treatment for medically refractory pituitary adenomas.
- |||||||||| dexamethasone / Generic mfg.
The Quest of Elevated Dhea-s: Is It a Tumor or Is It Ashwagandha? (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_851;
Laboratory evaluation showed AM cortisol of 21.6 ug/dL H (6.2-19.4 ug/dL), ACTH 6.2 pg/mL (7.2-63.3 pg/mL), DHEA-s >1000 ug/dL H (84.8-378 ug/dL), TSH 1.39 IU/mL (0.45-4.5 IU/mL), free t4 2.39 ng/dL H (0.82-1.77 ng/dL), IGF-1 252 ng/mL (91-308 ng/mL), 1mg dexamethasone suppression test resulted AM cortisol of 1.5 ug/dL (6.2-19.4 ug/dL)...TSH and free t4 improved to 0.789 IU/mL and free t4 1.43 ng/dL respectivelyConclusionThis case highlights that over the counter, readily available supplements that are marketed for reducing stress may cause remarkable alteration of natural physiology. Ashwagandha's use in men have been known to cause elevations in DHEA-s in men and this case highlights that Ashwagandha's use in women can also cause elevation in DHEA-s and how a simple intervention of eliminating Ashwagandha can improve DHEA-s levels
- |||||||||| abiraterone acetate / Generic mfg.
Mineralocorticoid Excess Syndrome with Abiraterone (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_850;
There is minimal literature on abiraterone induced endocrine side effects. This case will increase awareness of these and help endocrinologists individualize management of adverse effects experienced by prostate cancer patients on abiraterone.
- |||||||||| ritonavir / Generic mfg., fluticasone / Generic mfg.
Matters of the HAART - Ritonavir Induced CYP3A4 Inhibition of Intranasal Fluticasone Leading to Cushing's Syndrome (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_830;
Medications included emtricitabine-tenofovir-alafenamide and ritonavir at stable doses for several years. Educating patients on ritonavir about steroids being a component of many OTC medications/supplements, and a careful medication history and drug-drug interaction assessment is important in preventing steroid related adverse effects.
- |||||||||| dexamethasone / Generic mfg.
Osteopenia in the Setting of Mild Autonomous Cortisol Secretion (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_829;
A previous prospective study found that surgical cure of unilateral MACS may lead to a substantial risk reduction (up to 15-fold) of future incident asymptomatic vertebral fractures. Additionally, the highest risk for clinical fracture in those with adrenal adenomas (either nonfunctional or with cortisol hypersecretion) appears to occur at 7-10 years after initial diagnosis.
- |||||||||| desmopressin / Generic mfg.
Desmopressin Stimulation Test as a Valuable Tool in Establishing Cushing Syndrome Etiology (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_828;
Owing to increased mortality of untreated CS, it is essential for adequate identification of cause for curative therapy. We promote a non-invasive approach using the desmopressin stimulation test for successful identification in patients with discordant serum and imaging results.
- |||||||||| dexamethasone / Generic mfg., leuprolide acetate for depot suspension / Generic mfg., hydrocortisone / Generic mfg.
A Successful Ovulation Induction and Embryo Generation in a Woman With P450-Oxidoreductase Deficiency From Mutation G539R, Which Preferentially Impairs 17,20-Lyase Activity (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_826;
Very few examples of pregnancy in women with POR deficiency have been reported, and we describe the first example of successful ovulation induction and embryo generation in a woman with POR deficiency caused by the G539R mutation, which preferentially impairs 17,20-lyase activity. The complex array of steroid excess and deficiencies, from both adrenal and ovarian origin, must be systematically managed during assisted reproduction treatment for these women.
- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg.
Severe Exogenous Cushing Syndrome Caused by a Potent Steroid Concealed in Arthritis Supplement (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_818;
A study by Tucker.et.al. reported that 20% of dietary supplements have unapproved ingredients.1 This is especially concerning, considering that over half of the US population admits to taking dietary supplements.2 On April 2022, the FDA published a public notice for "Artri-King", declaring the presence of unlisted dexamethasone.3 Should such agents prove to be the culprit of CS, they must be tapered off gradually or in the presence of physiologic hydrocortisone to avoid the risk of adrenal crisis.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
A Curious Case of Immune Checkpoint Inhibitor Induced Hypophysitis with Transient ACTH-Dependent Hypercortisolism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_817;
We report a relatively novel irAE case of transient central hypercortisolism that progressed to hypopituitarism.A 72-year-old woman with metastatic melanoma on combined ICI therapy of nivolumab-ipilimumab developed subclinical hyperthyroidism (TSH <0.02 mU/L [reference range (RR) 0.40-4.50 mU/L]; FT4 20.2 pmol/L [RR 9.0-26.0 pmol/L]) eight weeks following initiation of her immunotherapy...The low dose dexamethasone suppression test was not suppressed (morning cortisol at 983 nmol/L)...The hydrocortisone and levothyroxine replacement were continued, and the patient remained asymptomatic throughout her follow-ups.This case highlights that a transient episode of ACTH dependent hypercortisolism may be an early marker prior to the development of central adrenal insufficiency from ICI-related destructive immune hypophysitis. Furthermore, our report highlights that physicians and other healthcare professionals should remain vigilant in monitoring laboratory progression in these patients, as early recognition facilitated timely management in our patient and prevented complications.
- |||||||||| Massive Adrenomyelolipomas Due to Longstanding CAH (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_816;
Massive adrenomyelolipomas are thought to be ACTH driven, especially seen in undertreated and longstanding CAH. Without the 21 hydroxylase enzyme to convert 17 OH Progesterone to 11 deoxycortisol, levels of ACTH rise.
- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg., midodrine hydrochloride / Generic mfg.
Recurrent Pericardial Effusion as Initial Presentation of Primary Adrenal Insufficiency (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_815;
Having a high clinical suspicion is crucial to a prompt diagnosis. Pericardial effusion should prompt clinical suspicion for PAI as multiple cases have now been reported in the literature.
- |||||||||| Pulmonary embolism before and after transsphenoidal surgery in Cushing's disease: case report. (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_814;
It was opted for clinical treatment with ketoconazole and anticoagulation for 6 months with transsphenoidal surgery...On the 5th postoperative day, laboratory tests revealed cortisol of 1.7 mcg/dL and ACTH of 6.3 pg/mL, suggesting remission of the disease and supplementation with prednisone... This case highlights the association of CS and thromboembolic events, especially Pulmonary Embolism.
- |||||||||| megestrol / Generic mfg.
Megestrol-Induced Adrenal Insufficiency (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_809;
SAI is often associated with prolonged glucocorticoid use but can also be seen in patients with pituitary tumors, pituitary surgery, or granulomatous disease. SAI can cause hyponatremia, hypoglycemia, and fatigue but is not typically associated with hypotension or hyperkalemia as the mineralocorticoid function of the adrenals remains intact.
- |||||||||| Autoimmune Polyglandular Syndrome II in a Young Female with Severe Weight Loss, DKA, and Psychiatric Features (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_808;
Frequent visits, vital checks, CMP, and antibody screening tests including GAD antibodies, anti-adrenal antibodies, and TPO antibodies help in diagnosing this syndrome earlier.Clinicians also should be mindful of psychiatric features in a patient. They should try to rule out medical causes before diagnosing a patient with psychiatric disease as profound hyponatremia can cause acute psychosis.
- |||||||||| hydrocortisone / Generic mfg.
Adrenal Insufficiency diagnosed during pregnancy (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_807;
Diagnosis of AI during pregnancy is rare as it is considered a hypercortisolemic state. Changes in cortisol levels during pregnancy make the diagnosis of AI even more challenging.
- |||||||||| ketoconazole / Generic mfg., trimethoprim/sulfamethoxazole / Generic mfg., hydrocortisone / Generic mfg.
Severe Cushing's Syndrome Due to Ectopic ACTH in Newly Diagnosed Small Cell Lung Cancer: The Pivotal Role of Etomidate in Acute Treatment (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_806;
Hypercortisolism comorbidities were treated appropriately: trimethoprim-sulfamethoxazole for pneumocystis pneumonia prophylaxis, anticoagulation for DVT prophylaxis, antibiotics for acute diverticulitis, and insulin for hyperglycemia...While effective, this strategy poses risks of etomidate toxicity and makes serum cortisol interpretation unreliable. Etomidate analogs are on the horizon that retain the potent adrenostatic action of etomidate without its sedative-hypnotic activity, offering an alternative treatment option for treating patients with severe CS in non-ICU hospital settings.
- |||||||||| Lysodren (mitotane) / HRA Pharma
Therapeutic Dosing of Steroids in Patients on Mitotane (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_803;
Her other home medications included mitotane 500mg QID and hydrocortisone 180mg (40mg-40mg-30mg -20mg QID)...Best Practice & Research Clinical Endocrinology & Metabolism, 34(3), 101415. https://doi.org/10.1016/j.beem.2020.101415
- |||||||||| Erbitux (cetuximab) / Eli Lilly, EMD Serono
Dual Cause of Hypercalcemia: Can both multiple myeloma and paraneoplastic parathyroid-related hormone production occur simultaneously? (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_785;
At the time of evaluation in September 2022, she was actively on cetuximab chemotherapy and completed her initial radiation...The patient improved with medical management for the hypercalcemia and was started on dexamethasone for the multiple myeloma...Our patient had hypercalcemia due to high PTHrP from squamous cell carcinoma as well as newly diagnosed multiple myeloma. This case highlights the importance of recognizing that hypercalcemia may be multifactorial and a complete evaluation is needed to treat all causes appropriately.
- |||||||||| Olumiant (baricitinib) / Incyte, Eli Lilly
COVID-19 Pneumonia and Primary Hyperparathyroidism Exacerbation (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_737;
However, a significant rise in Ca approaching parathyroid crisis range was seen shortly thereafter, despite normalization of Cr.Whereas hypocalcemia has been noted in most cases of Ca dysfunction associated with COVID-19 infection, in this case, we postulate that the COVID-19 infection may have triggered parathyroiditis, thus exacerbating the underlying PHPT.One such mechanism is the use of receptors like angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) by COVID-19 virus, which are found on endocrine glands including the parathyroid. Similarly, COVID-19 virus exerts its inflammatory effects using IL-6, which is also a key cytokine that causes hypercalcemia by stimulating bone resorption.Furthermore, COVID-19 infection is notorious for causing nausea/vomiting, and diarrhea, culminating in dehydration which worsens hypercalcemia.It is therefore necessary that physicians foresee impending complications of COVID-19 infection with concurrent parathyroid disease and take early steps to prevent and treat them.
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg.
Doege-Potter Syndrome in a Patient with Solitary Fibrous Tumor of the Lung (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_714;
A ratio of IGF-2/IGF-1 more than 10 confirms NICTH; however, normal ratio cannot exclude the diagnosis and factors such as low IGFBP 3 or steroid therapy for other conditions need to be considered. Surgery is the mainstay of treatment.
- |||||||||| dexamethasone / Generic mfg., prednisone / Generic mfg.
Paraneoplastic Hypoglycemia Secondary to Hepatocellular Carcinoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_710;
Overall, paraneoplastic hypoglycemia associated with HCC has very poor prognosis and high mortality rate. There is no single effective management and combination of steroids and Somatropin may provide palliative improvement as seen in our patient.
- |||||||||| hydrocortisone / Generic mfg., acarbose / Generic mfg.
Sugar Crash: A Case of Recurrent Hypoglycemia (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_709;
RYGB increases stimulation of islet ?-cells by enteral signals and enhances GLP-1 sensitivity and insulin secretion, predisposing some individuals to hypoglycemic episodes. Patients may have remission of diabetes and no longer need medications post-operatively.
- |||||||||| Tecentriq (atezolizumab) / Roche
Metastatic Insulinoma Diagnosed Postpartum (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_659;
Liver biopsy revealed well-differentiated neuroendocrine tumor, WHO grade 3 likely from a pancreatic primary and chemotherapy was initiated with carboplatin and paclitaxel with some response...She was also given octreotide, hydrocortisone, and eventually diazoxide...Tumor board meeting was held and her chemotherapy regimen was changed to Carboplatin/Etoposide/Atezolizumab...Given the degree of extensive metastases at time of presentation, we expect our patient's insulinoma was present prior to delivery. Hypoglycemia may have only manifested in the postpartum period when there was decreased levels of placenta-derived counterregulatory hormones.
- |||||||||| A rare case of acute Sheehan's Syndrome in an antepartum patient (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_583;
In our case, septic shock caused an abrupt onset of persistent hypotension leading to hormone levels suggestive of panhypopituitarism while the patient was pregnant at 31 weeks of gestation, which has not been reported in prior literature. While known as a chronic diagnosis in the postpartum population, further research should explore possible stunning effect of acute hypotension manifesting as acute SS in peripartum patients.
- |||||||||| Bystolic (nebivolol) / Menarini, AbbVie
Catching a Chimera: A Case of Suspected Glucocorticoid Remediable Aldosteronism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_539;
Elevated levels of urine 18-hydroxycortisol and 18-oxocortisol are also noted but these are not widely available tests. Treatment of GRA is with medical management only; since surgical intervention is not required; proper diagnosis can also save the patient from unnecessary and invasive tests such as adrenal vein sampling.
- |||||||||| dexamethasone / Generic mfg., desmopressin / Generic mfg.
Alcohol-induced Non-neoplastic Hypercortisolism: Report of Eight Cases and Review of the Literature (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_538;
Treatment of GRA is with medical management only; since surgical intervention is not required; proper diagnosis can also save the patient from unnecessary and invasive tests such as adrenal vein sampling. All eight patients had abnormal low-dose dexamethasone suppression test (DST) [post DST serum cortisol 2.2-19.1 mcg/dL (RIALT) and subnormal ACTH and cortisol responses to dDAVP may be helpful in distinguishing AIH from neoplastic hypercortisolism.
- |||||||||| dexamethasone / Generic mfg.
Post-adrenalectomy Improvement of Kidney Function in Patients with Mild Autonomous Cortisol Secretion and Nonfunctioning Adrenal Adenoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_534;
In this study, we aimed to assess the factors associated and the degree and timing of change in kidney function post adrenalectomy in patients with MACS or nonfunctioning adrenal adenoma (NFA).We conducted a retrospective single-center study and included adult patients with MACS or NFA diagnosed based on a post-dexamethasone cortisol cutoff of 1.8 mcg/dL, who underwent adrenalectomy between 1999-2022...Patients with MACS and NFA demonstrate improvement of eGFR over the 3.5 years of follow up post-adrenalectomy. The factors that are associated with improvement of eGFR are lower eGFR before surgery, younger age at time of adrenalectomy and longer follow up post adrenalectomy.
- |||||||||| dexamethasone / Generic mfg.
Impact of Adrenalectomy on Cognition in Patients with Mild Autonomous Cortisol Secretion (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_533;
We showed that adrenalectomy in patients with MACS is associated with improvement in cognition. However, as test results may improve with practice (i.e., improvement due to taking the test the second time), to determine whether the improvements observed represent a reliable change in cognition, the next step is to evaluate for cognition score changes in referent subjects.
- |||||||||| Korlym (mifepristone) / Corcept Therap, Mifeprex (mifepristone) / Danco Laboratories
Phase 4 Study of Hypercortisolism in Patients with Difficult-to-Control Type 2 Diabetes Despite Receiving Standard-of-Care Therapies: Prevalence and Treatment with Mifepristone (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_532;
In Part 1, approximately 1000 persons with difficult-to-control T2D will be screened with a 1-mg dexamethasone suppression test...Part 2 will assess the secondary endpoint of change in HbA1c from baseline to 24 weeks, as well as changes in hypercortisolism-related comorbidities (e.g., blood pressure, weight, waist circumference, quality of life). This will be the first prospective study to assess the prevalence of ACTH-independent hypercortisolism in persons with difficult-to-control T2D and the first prospective, randomized, placebo-controlled trial to assess the potential benefits and safety of treatment with mifepristone in this patient population.
|
