“The human body is the best picture of the human soul.” – Tony Robbins
PNA Medical Corner:
Endogenous Cushing’s and Cancer
Dr. Maria Fleseriu
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.
© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
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
Featured News and Updates
News Articles April 2026
Pituitary story: 10-year-old pituitary patient honored for bravery
A ten-year-old Scottish girl has been honored for her bravery as she underwent surgery for a pituitary tumor. Read more: https://www.northern-times.co.uk/news/she-s-an-absolute-star-inverness-pupil-honoured-for-brave-431104/
Teen overcomes Cushing’s Disease
A 17-year-old girl in North Carolina is doing well after surgery to remove a pituitary tumor caused by Cushing’s Disease. She is an avid runner who suffered headaches and fatigue before her diagnosis. Read more: https://www.wect.com/2026/04/01/believe-them-teen-runner-diagnosed-with-rare-cushings-disease-after-years-symptoms/
Pituitary story: Cushing’s at age 27
A 27-year-old woman experienced a lack of menses and unexplained weight gain before being diagnosed with Cushing’s disease. She had surgery at Cleveland Clinic in Florida and has returned to a normal life. Read more: https://my.clevelandclinic.org/patient-stories/960-in-her-twenties-yoselin-needed-pituitary-tumor-surgery
Mobile MRI during pituitary surgery
An article on MSN.com looks at the use of mobile brain scanners during pituitary surgery in Canada. Read more: https://www.msn.com/en-ca/health/other/mobile-brain-scans-sound-like-science-fiction-but-they-re-now-helping-more-canadian-patients/ar-AA1YlZWc
Research Articles
Research Articles April 2026
Pituitary Tumors
Li J, Qu Y, Zhang W, Yang Z, Zeng Y, Xu J, Xie K, Liu Q.Int J Mol Med. 2026 Jun;57(6):151. doi: 10.3892/ijmm.2026.5822. Epub 2026 Apr 3.
Dzhatieva DN, Pigarova EA, Dzeranova LK.Zh Vopr Neirokhir Im N N Burdenko. 2026;90(2):98-102. doi: 10.17116/neiro20269002198.
[Impact of cabergoline on fibrosis in prolactinoma].
Matsueva IA, Paltsev AA, Guseva KA, Tsoy UA, Grineva EN.Zh Vopr Neirokhir Im N N Burdenko. 2026;90(2):85-91. doi: 10.17116/neiro20269002185.
Klochkova IS, Astafyeva LI, Kutin MA, Konovalov AN, Sidneva YG, Shkarubo AN, Kalinin PL.Zh Vopr Neirokhir Im N N Burdenko. 2026;90(2):77-84. doi: 10.17116/neiro20269002177.
Fedai NK, Uzun N, Bostan H, Kizilgul M, Demirci T, Cakal E, Ucan B.Hormones (Athens). 2026 Apr 2. doi: 10.1007/s42000-026-00766-3. Online ahead of print.
Lozouet M, Saadoun A, Ménard A, Aldea S, Jaoude SA, Heran F, Yavchitz A, Philibert M, Chauvet D.Clin Neurol Neurosurg. 2026 Mar 28;267:109409. doi: 10.1016/j.clineuro.2026.109409. Online ahead of print.
Hajikarimloo B, Mohammadzadeh I, Tos SM, Bahri A, Sabaghian A, Habibi MA.Endocrine. 2026 Apr 1;91(1):118. doi: 10.1007/s12020-026-04590-y.
Pituitary disorders
Recurrent pituitary apoplexy: experience from a national registry and review of the literature.
Biagetti B, Cordero Asanza E, Iglesias P, Camara R, Asla Q, Vicente A, Martinez-Saez E, Sarria-Estrada S, Puig-Domingo M, Araujo-Castro M.Ther Adv Endocrinol Metab. 2026 Mar 28;17:20420188261434641. doi: 10.1177/20420188261434641. eCollection 2026.
Post-Traumatic Pituitary Stalk Transection Syndrome.
Albusaidi R, AlHatmi A, Al Shidhani A, Al-Ajmi E.Sultan Qaboos Univ Med J. 2026 Mar 7;26(1):230-232. doi: 10.18295/2075-0528.2977. eCollection 2026.
Al-Shamkhi N, Edén Engström B, Rask E, Anderzén-Carlsson A.PLoS One. 2026 Mar 31;21(3):e0345909. doi: 10.1371/journal.pone.0345909. eCollection 2026.
Valeri F, Zoli M, Lillo S, Tengattini F, Colombo F, Pasquini E, Salierno G, Carretta A, D’Ambrosio L, Babaei D, Agosti E, Mattogno PP, Fontanella MM, Lauretti L, Mazzatenta D, Doglietto F, Iannalfi A.Neurosurg Rev. 2026 Mar 31;49(1):331. doi: 10.1007/s10143-026-04258-1.
Cushing’s
Chen B, He C, Han L, Wang H, Ma Y, Wang R, Cai X.Onco Targets Ther. 2026 Feb 6;19:571776. doi: 10.2147/OTT.S571776. eCollection 2026.
Jamal HF.JCEM Case Rep. 2026 Mar 31;4(4):luag039. doi: 10.1210/jcemcr/luag039. eCollection 2026 Apr.
Mangone A, Sala E, Carosi G, Sindaco GD, Mungari R, Cremaschi A, Petria I, Noschese G, Lotito V, Mantovani G, Ferrante E.Pituitary. 2026 Apr 1;29(2):68. doi: 10.1007/s11102-026-01668-8.
Rivera-Martínez WA, Ramírez Castaño MJ, Cruz Calderón S, Díaz Posada NA, Gutiérrez Restrepo J, Román-González A, Aristizábal Henao N, Castaño Ceballos PA, Tobón Ospina CI, Donado Gómez JH, López Pompey N, Builes-Montaño CE.Ther Adv Endocrinol Metab. 2026 Mar 28;17:20420188261434078. doi: 10.1177/20420188261434078. eCollection 2026.
Nitya AAV, Ghosh J, Taneja S, Singla V, Kalra N, Dutta P.Indian J Endocrinol Metab. 2026 Jan-Feb;30(1):79-84. doi: 10.4103/ijem.ijem_821_25. Epub 2026 Feb 27.
Quan W, Zhao DW, Li L, Chen HR, Wang L, Hu SL, Hu R.World Neurosurg. 2026 Mar 28:124958. doi: 10.1016/j.wneu.2026.124958. Online ahead of print.PMID: 41912140
Acromegaly
Meningoencephalitis and secondary pituitary abscess in a 16-year-old patient with gigantism.
Wissa M, Strenger V, Weinhandl G, Braun H, Wolfsberger S, Micko A.JCEM Case Rep. 2026 Apr 1;4(4):luag032. doi: 10.1210/jcemcr/luag032. eCollection 2026 Apr.
The silent surden: Alexithymia and quality of life in acromegaly patients.
Soltanova L, Aygun AB, Kocaman BB, Muradov I, Taze SS, Turan S, Kadioglu P, Durcan E.Endocrine. 2026 Apr 2;91(1):135. doi: 10.1007/s12020-026-04606-7.
To test or not to test: what we have learnt from 50 years of dynamic testing in acromegaly.
De Marinis L, Chiloiro S, Mancini A, Giambò P, Giampietro A, Bianchi A, Pontecorvi A, Giustina A.Pituitary. 2026 Mar 31;29(2):67. doi: 10.1007/s11102-026-01649-x.
Tsatsaris E, Robèrt J, Burman P, Berinder K, Bonelli L, Dahlqvist P, Höybye C, Ragnarsson O, Vouzouneraki K, Åkerman AK, Ekman B, Engström BE.J Clin Endocrinol Metab. 2026 Mar 30:dgag137. doi: 10.1210/clinem/dgag137. Online ahead of print.PMID: 41913644
Acromegaly-Physiopathology and etiology.
Castinetti F.Vitam Horm. 2026;131:83-102. doi: 10.1016/bs.vh.2026.01.001. Epub 2026 Jan 28.PMID: 41912301 Review.
Co-secreting pituitary adenomas in acromegaly: Classification, diagnosis, and treatment strategies.
Biagetti B, Araujo-Castro M.Vitam Horm. 2026;131:41-57. doi: 10.1016/bs.vh.2025.06.002. Epub 2025 Dec 3.
Acromegaly and histopathology.
Caballero GA, Ribalta T, Aldecoa I.Vitam Horm. 2026;131:293-334. doi: 10.1016/bs.vh.2025.10.007. Epub 2025 Nov 13.PMID: 41912298 Review.
New molecular markers of response to medical therapy in acromegaly.
Raventós A, Gil J, Marques-Pamies M, de Pedro-Campos P, Puente de la Vega C, Picó A, Lamas C, Delgado E, Menéndez E, Serra G, Bernabéu I, Villar R, Ferri J, Mariaca K, Martínez R, Marazuela M, Araujo-Castro M, Biagetti B, Jordà M, Valassi E, Puig-Domingo M; ACROMICS investigators.Vitam Horm. 2026;131:265-292. doi: 10.1016/bs.vh.2025.10.006. Epub 2025 Nov 12.
de Lapiscina IM, Baquero C, Castaño L.Vitam Horm. 2026;131:235-263. doi: 10.1016/bs.vh.2025.10.008. Epub 2025 Dec 16.PMID: 41912295 Review.
Donato S, Regala C, Marques P.Vitam Horm. 2026;131:195-234. doi: 10.1016/bs.vh.2025.10.005. Epub 2026 Feb 16.PMID: 41912294 Review.
Hormonal Health
Wu H, Jian MT, Ning G, Li BN, Peng AJ, Wang HY, Tang X, Zhou X.Asian J Androl. 2026 Apr 3. doi: 10.4103/aja2025105. Online ahead of print.
From the perspective of prolactin: a view on obesity.
Wang Y, Luo D, Fang G, Ge M, Huang Y, Deng H.Front Endocrinol (Lausanne). 2026 Mar 16;17:1762596. doi: 10.3389/fendo.2026.1762596. eCollection 2026.
Gonadotropins Across the Lifespan: Their role in the Neurodevelopment-Neurodegeneration Continuum.
Galbraith JA, Elhassan MZ, Rocha JF, Al Mozani TA, Fredericks CA.Yale J Biol Med. 2026 Mar 31;99(1):199-215. doi: 10.59249/EVST3084. eCollection 2026 Mar.
Dayno AN, Crowley J, Bamba V, Bhoj EJK, Shekdar K, McCormack SE.Neoreviews. 2026 Apr 1;27(4):e211-e221. doi: 10.1542/neo.27-4-002.
Unconventional Uses of Human Growth Hormone.
Lisbona-Buzali M, Edid-Jaris G, Alegre-Lifshitz A, Mercado-Medrez S, Taniguchi-Ponciano K, Marrero-Rodriguez D, Mercado M.Arch Med Res. 2026 Mar 30;57(5):103412. doi: 10.1016/j.arcmed.2026.103412. Online ahead of print.PMID: 41915988 Review.
Elia A.Arch Endocrinol Metab. 2026 Jun 1;70(3):e260025. doi: 10.20945/2359-4292-2026-0025.
TRH can stimulate the release of two POMC-derived pituitary hormones, ACTH and MSH, in medaka.
Yamakawa M, Gajbhiye DS, Golan M, Kanda S.Endocrinology. 2026 Mar 30:bqag037. doi: 10.1210/endocr/bqag037. Online ahead of print.
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)
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