“The human body is the best picture of the human soul.” – Tony Robbins

PNA Medical Corner:

Endogenous Cushing’s and Cancer

Dr. Maria Fleseriu

This month the PNA Medical Corner features a study co-authored by Maria Fleseriu, a  longtime member of the PNA and Professor of Endocrinology and Neurological Surgery and Director of the Pituitary Center at Oregon Health & Science University.  The study finds that endogenous Cushing’s Syndrome is linked to higher risk of cancer.

Eur J Endocrinol

2024 Jul 27:lvae098.

 doi: 10.1093/ejendo/lvae098. Online ahead of print.

Endogenous Cushing’s Syndrome and Cancer Risk

Yaron Rudman ^1 2, Maria Fleseriu ³, Laura Dery ², Hiba Masri-Iraqi ^1 2, Liat Sasson ^1 2, Tzipora Shochat ⁴, Shiri Kushnir ⁵, Ilan Shimon ^1 2, Amit Akirov ^1 2

Affiliations Expand

• PMID: 39067000    DOI: 10.1093/ejendo/lvae098

Abstract

Objective: Cancer incidence in patients with endogenous Cushing’s syndrome (CS) has never been established. We aimed to assess the cancer risk in patients with CS, as compared with individually matched controls.

Design: A nationwide retrospective matched-cohort study of patients with endogenous CS diagnosed between 2000-2023, using the database of Clalit Health Services in Israel.

Methods: Patients with adrenal carcinoma or ectopic CS were excluded. Patients with CS were matched in a 1:5 ratio, with controls individually matched for age, sex, socioeconomic status, and body mass index. The primary outcome was defined as the first diagnosis of any malignancy following a CS diagnosis. Risk of malignancy was calculated using the Cox proportional hazards model with death as a competing event.

Results: A total of 609 patients with CS and 3018 controls were included [mean age at diagnosis, 48.0±17.2 years; 2371 (65.4%) women]. The median follow-up 14.7 years (IQR, 9.9-20.2 years).Patients with CS had an increased cancer risk, with hazard ratio (HR) of 1.78 (95% CI 1.44-2.20), compared with their matched controls. The risk of malignancy was elevated in patients with Cushing’s disease (251 cases and 1246 controls; HR 1.65, 95% CI 1.15-2.36) and in patients with adrenal CS (200 cases and 991 controls; HR 2.36, 95% CI 1.70-3.29). The increased cancer risk in patients with CS persists after exclusion of thyroid malignancies.

Conclusion: Endogenous CS is associated with increased malignancy risk. These findings underscore the need for further research to establish recommendations for cancer screening in this population.

Keywords: Adrenal; Cancer; Cushing’s disease; Cushing’s syndrome; Malignancy; Pituitary.

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Reversing vision loss with successful pituitary tumor surgery

Pituitary tumors often cause vision problems. That’s because the optic nerves, which connect the eye to the brain, are located just on top of the pituitary gland. Pituitary tumors can grow

in a way that causes them to compress the optic nerves, leading to vision loss.

“Often the visual loss starts with the peripheral vision and is quite subtle,” says Mayo Clinic neurosurgeon Dr. Maria Peris Celda. “Pituitary tumors usually grow slowly and over time, people can get used to the visual loss. They may not notice the problem until the larger tumor affects their central vision.”

Fortunately, vision loss is often reversed once the tumor is surgically removed. The most common procedure is endoscopic endonasal transsphenoidal surgery. The endoscope, a small surgical camera, and surgical instruments are placed through the nostrils to access the tumor through the sinuses.

“We don’t have to make any incisions in the face,” Dr. Peris Celda says. “Very often, the visual loss either improves or is completely resolved after the operation.” Mayo Clinic was among the first institutions to extensively research the endoscopic through-the-nose approach. Now standard practice, the procedure lowers discomfort and usually requires only an overnight stay in the hospital.

ENT nose and sinus surgeons work alongside neurosurgeons during these procedures. For challenging cases, patients can benefit from the care provided by neuro-ophthalmologists: subspecialists who treat vision issues linked to neurological conditions.

Successful pituitary tumor surgery requires detailed imaging. “The pituitary gland is located in a delicate area, surrounded by very important blood vessels and nerves,” Dr. Peris Celda says. “Using the latest MRI technology allows us to understand the relationship between the tumor, brain and other important structures.”

Vision problems are just one type of complication that pituitary tumors can cause. “A specialized team that focuses on skull base diseases can help provide patients with the best possible outcomes and return to normal quality of life,” Dr. Peris Celda says.

Mayo Clinic is one of the leading pituitary centers in the U.S.  For more information, please visit careinfo.mayoclinic.org/pituitary-tumor 

Count on your Xeris CareConnection™ Team for unparalleled Cushing’s Support

Cushing’s can be challenging, but there is support so patients can feel like themselves again. The main goal of treating Cushing’s is to get cortisol levels back to normal. This Pituitary Awareness Month, Xeris Pharmaceuticals® is highlighting the importance of one-on-one support for patients living with Cushing’s Syndrome and support for HCPs treating Cushing’s Syndrome.

Sign up to get dedicated support:

Patients: Sign up for support | Recorlev® (levoketoconazole)

HCP’s: Connect with Xeris support | RECORLEV® (levoketoconazole)

Have more questions? Call for more support at 1-844-444-RCLV (7258)