{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T01:37:46Z","timestamp":1750815466544,"version":"3.37.3"},"reference-count":23,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>When transsphenoidal surgery (TSS) does not cure Cushing's disease (CD), 4 treatments are available: drug treatment (DT), second TSS (2nd TSS), bilateral adrenalectomy (BA), and pituitary radiotherapy (PR). DT is attractive but supposes long-term continuation, which we aimed to evaluate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and Methods<\/jats:title>\n                  <jats:p>Retrospective study, in a center prioritizing 2nd TSS, of 36 patients, including 19 with TSS failure and 17 with recurrence, out of 119 patients with CD treated by a first TSS, average follow-up 6.1 years (95% confidence interval 5.27-6.91). Control was defined as normalization of urinary free cortisol (UFC) and final treatment (FT) as the treatment allowing control at last follow-up. We also analyzed discontinuation rates of DT in published CD prospective clinical trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Control was achieved in 33\/36 patients (92%). DT was initiated in 29\/36 patients (81%), allowing at least 1 normal UFC in 23\/29 patients (79%) but was discontinued before last follow-up in 18\/29 patients (62%). DT was FT in 11\/29 patients (38%), all treated with cortisol synthesis inhibitors. Second TSS was FT in 8\/16 (50%), BA in 14\/14 (100%), and PR in 0\/5. In published trials, discontinuation of DT was 11% to 51% at 1 year and 32% to 74% before 5 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>DT allowed at least 1 normal UFC in 23\/29 patients (79%) but obtained long-term control in only 11\/29 (38%), as discontinuation rate was high, although similar to published data. Interestingly, a successful 2nd TSS was the cause for discontinuing efficient and well-tolerated DT in 5 patients. Further studies will show whether different strategies with cortisol synthesis inhibitors may allow for a lower discontinuation rate in patients not candidates for a 2nd TSS so that BA may be avoided in these patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgad662","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T18:42:47Z","timestamp":1699987367000},"page":"1000-1011","source":"Crossref","is-referenced-by-count":6,"title":["Discontinuation of Drug Treatment in Cushing's Disease Not Cured by Pituitary Surgery"],"prefix":"10.1210","volume":"109","author":[{"given":"Adel","family":"Ghalawinji","sequence":"first","affiliation":[{"name":"Department of Endocrinology CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"Drezet","sequence":"additional","affiliation":[{"name":"National Institute of Engineering , 38031 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7954-2798","authenticated-orcid":false,"given":"Philippe","family":"Chaffanjon","sequence":"additional","affiliation":[{"name":"Department of Endocrine and Thoracic Surgery CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Endocrinology CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Sturm","sequence":"additional","affiliation":[{"name":"Department of Pathology CHU Grenoble Alpes, University Grenoble Alpes, 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Simiand","sequence":"additional","affiliation":[{"name":"Department of Endocrinology CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnaud","family":"Lazard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Gay","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8756-7218","authenticated-orcid":false,"given":"Olivier","family":"Chabre","sequence":"additional","affiliation":[{"name":"Department of Endocrinology CHU Grenoble Alpes, University Grenoble Alpes , 38043 Grenoble , France"},{"name":"Unit\u00e9 Mixte de Recherche, INSERM-CEA-UGA UMR1292 , 38000 Grenoble , 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