{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T15:41:30Z","timestamp":1772034090769,"version":"3.50.1"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Surgery is the definitive treatment of Cushing\u2019s syndrome (CS) but medications may also be used as a first-line therapy. Whether preoperative medical treatment (PMT) affects postoperative outcome remains controversial.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>(1) Evaluate how frequently PMT is given to CS patients across Europe; (2) examine differences in preoperative characteristics of patients who receive PMT and those who undergo primary surgery and (3) determine if PMT influences postoperative outcome in pituitary-dependent CS (PIT-CS).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Patients and methods<\/jats:title>\n<jats:p>1143 CS patients entered into the ERCUSYN database from 57 centers in 26 countries. Sixty-nine percent had PIT-CS, 25% adrenal-dependent CS (ADR-CS), 5% CS from an ectopic source (ECT-CS) and 1% were classified as having CS from other causes (OTH-CS).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Twenty per cent of patients took PMT. ECT-CS and PIT-CS were more likely to receive PMT compared to ADR-CS (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Most commonly used drugs were ketoconazole (62%), metyrapone (16%) and a combination of both (12%). Median (interquartile range) duration of PMT was 109 (98) days. PIT-CS patients treated with PMT had more severe clinical features at diagnosis and poorer quality of life compared to those undergoing primary surgery (SX) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Within 7 days of surgery, PIT-CS patients treated with PMT were more likely to have normal cortisol (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) and a lower remission rate (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Within 6 months of surgery, no differences in morbidity or remission rates were observed between SX and PMT groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>PMT may confound the interpretation of immediate postoperative outcome. Follow-up is recommended to definitely evaluate surgical results.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-17-0997","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T15:43:56Z","timestamp":1518536636000},"page":"399-409","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":45,"title":["Preoperative medical treatment in Cushing\u2019s syndrome: frequency of use and its impact on postoperative assessment: data from ERCUSYN"],"prefix":"10.1093","volume":"178","author":[{"given":"Elena","family":"Valassi","sequence":"first","affiliation":[{"name":"1IIB-Sant Pau and Department of Endocrinology\/Medicine, Hospital Sant Pau, UAB, and Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain"}]},{"given":"Holger","family":"Franz","sequence":"additional","affiliation":[{"name":"2Lohmann & Birkner Health Care Consulting GmbH, Berlin, Germany"}]},{"given":"Thierry","family":"Brue","sequence":"additional","affiliation":[{"name":"3Aix-Marseille Universit\u00e9, CNRS, CRN2M UMR 7286, Marseille, France"},{"name":"4APHM, H\u00f4pital Conception, Marseille, France"}]},{"given":"Richard A","family":"Feelders","sequence":"additional","affiliation":[{"name":"5Erasmus University Medical Centre, Rotterdam, The Netherlands"}]},{"given":"Romana","family":"Netea-Maier","sequence":"additional","affiliation":[{"name":"6Radboud University Medical Centre, Nijmegen, The Netherlands"}]},{"given":"Stylianos","family":"Tsagarakis","sequence":"additional","affiliation":[{"name":"7Athens Polyclinic General Hospital, Evangelismos Hospital, Athens, Greece"}]},{"given":"Susan M","family":"Webb","sequence":"additional","affiliation":[{"name":"1IIB-Sant Pau and Department of Endocrinology\/Medicine, Hospital Sant Pau, UAB, and Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain"}]},{"given":"Maria","family":"Yaneva","sequence":"additional","affiliation":[{"name":"8Medical University of Sofia, Sofia, Bulgary"}]},{"given":"Martin","family":"Reincke","sequence":"additional","affiliation":[{"name":"9Medizinische Klinik und Poliklinik IV, Campus Innestadt, Klinikum der Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Germany"}]},{"given":"Michael","family":"Droste","sequence":"additional","affiliation":[{"name":"10Praxis f\u00fcr Endokrinologie Droste, Oldenburg, Germany"}]},{"given":"Irina","family":"Komerdus","sequence":"additional","affiliation":[{"name":"11Moscow Regional Research Clinical Institute n.a. 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