Once again, the CSRF exhibited at the annual meeting of The Endocrine Society; this year’s meeting was held in Boston. The booth was staffed by Karen Campbell, Dave Campbell, Louise Pace and Danielle Reszenski. Heather Shaw, the graphic designer of our newsletter also attended for a day as did 16-year-old Ashley Cadorette and her mother. The booth location was very good as we were next to The Pituitary Society booth and very close to the adrenal and neuroendocrine posters. This was definitely one of the better booth locations we have had and booth traffic reflected that.
This year marked the 100th anniversary of The Endocrine Society, thus some symposia included a historical perspective. A summary of such a symposium on Cushing’s is a separate article under Conference Reports. Some of the authors responded to our questions about work they presented at the meeting. Those questions and answers appear in Doctor’s Answers section of our website. This year The Endocrine Society Guideline on Treatment of Hypopituitarism was presented and we will highlight that once the guideline is published. There were many excellent presentations and posters. What follows is a very brief summary of a few of the presentations.
Cushing’s disease patients (pituitary tumor) always want to know if it is possible to predict whether a given patient will have recurrent disease. Measurements of cortisol and ACTH have not been able to predict this risk. Balomenaki M., et al (Evangelismos Hospital, Athens, Greece) reported that a significant number of patients with pituitary Cushing’s show abnormal responses on a DDAVP (desmopressin) test done prior to surgery. Response to DDAVP was also evaluated post-surgery in 34 patients. These authors found that a remaining response to DDAVP following surgery correlated with recurrence during the follow up period (median ~ 40 months) and that a lack of response after surgery was suggestive of sustained remission. Obviously, data is needed from more patients and over a longer period of time.
Singh I., et al (UCLA, Los Angeles) investigated the fall in cortisol post successful surgery in Cushing’s disease patients. Out of 50 successful pituitary surgeries, 63% experienced a drop in cortisol to <2ug/dL in less than 24hrs, 32.4% in 24-48 hours and about 5% in 48-60 hours.
Adrenal Incidentalomas and Subclinical Cushing’s Syndrome (SCS)
There were a number of studies that addressed the area of accidentally discovered adrenal masses (adrenal incidentalomas or AI) found on CT or MRI that was done for another purpose. The vast majority of these are non-functional, however, some have been found to result in subtle abnormal cortisol test results. This can put the patient at risk for metabolic conditions even without the development of overt Cushing’s. Thus, this is termed Subclinical Cushing’s Syndrome (SCS).
Debono M., et al (University of Sheffield, UK) investigated the cortisol secretion profile in a small number of patients with AI and SCS. These authors found that in their patients, cortisol exposure increased starting in the early evening compared to normal controls. These authors went on to administer metyrapone, a short acting cortisol synthesis blocker, in the early evening and at bedtime. Data presented showed that such administration “re-set” the normal circadian rhythm of cortisol being lowest at night. This “re-set” also decreased levels of IL6 which is a marker of cardiovascular risk.
You can read the abstracts yourself by selecting Endo 2016, Scientific Program at: https://www.endocrine.org/meetings/endo-annual-meetings
Author: Karen Campbell, reviewed by Dr. James Findling, Summer 2016