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Article ; Online: Patient and Provider Perspectives on Postsurgical Recovery of Cushing Syndrome.

Acree, Rachel / Miller, Caitlin M / Abel, Brent S / Neary, Nicola M / Campbell, Karen / Nieman, Lynnette K

Journal of the Endocrine Society

2021 Volume 5, Issue 8, Page(s) bvab109

Abstract: Context: Cushing syndrome (CS) is associated with impaired health-related quality of life (HRQOL) even after surgical cure.: Objective: To characterize patient and provider perspectives on recovery from CS, drivers of decreased HRQOL during recovery, ...

Abstract	Context: Cushing syndrome (CS) is associated with impaired health-related quality of life (HRQOL) even after surgical cure. Objective: To characterize patient and provider perspectives on recovery from CS, drivers of decreased HRQOL during recovery, and ways to improve HRQOL. Design: Cross-sectional observational survey. Participants: Patients (n = 341) had undergone surgery for CS and were members of the Cushing's Support and Research Foundation. Physicians (n = 54) were Pituitary Society physician members and academicians who treated patients with CS. Results: Compared with patients, physicians underestimated the time to complete recovery after surgery (12 months vs 18 months, Conclusion: Poor communication between physicians and CS patients may contribute to dissatisfaction with the postsurgical experience. Increased information on recovery, including helpful coping mechanisms, and improved provider-physician communication may improve HRQOL during recovery.
Language	English
Publishing date	2021-06-14
Publishing country	United States
Document type	Journal Article
ISSN	2472-1972
ISSN (online)	2472-1972
DOI	10.1210/jendso/bvab109
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Article ; Online: Adrenal insufficiency: etiology, diagnosis and treatment.

Neary, Nicola / Nieman, Lynnette

Current opinion in endocrinology, diabetes, and obesity

2008 Volume 17, Issue 3, Page(s) 217–223

Abstract: Purpose of review: Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2010 because of its lethal nature.: Recent findings: Reports illuminate features of adrenal insufficiency cause, diagnosis and treatment, and the ... ...

Abstract	Purpose of review: Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2010 because of its lethal nature. Recent findings: Reports illuminate features of adrenal insufficiency cause, diagnosis and treatment, and the role of glucocorticoids in critical illness. Summary: Progress has been made in identifying human leukocyte antigen and major histocompatability complex alleles that predispose to the development of adrenal insufficiency in patients with antibodies to 21-hydroxylase, but their role in clinical care is not established. Reports of HIV-associated infections and medication-induced hypocortisolism are reminders that autoimmune adrenal destruction does not underlie all cases. The diagnosis is adequately established by the 250 microg adrenocortocotropin hormone stimulation test in most patients; the 1 microg test carries the risk of misdiagnosis of healthy individuals as adrenally insufficient. Glucocorticoids provide life-saving treatment, but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. The current recommended total daily dose is lower than that often prescribed. Dehydroepiandrosterone replacement may be useful in pubertal girls with hypopituitarism, but not in adults. Supraphysiologic hydrocortisone doses may aid in the reversal of septic shock independent of underlying adrenal function.
MeSH term(s)	Adrenal Insufficiency/diagnosis ; Adrenal Insufficiency/drug therapy ; Adrenal Insufficiency/etiology ; Adrenocorticotropic Hormone/metabolism ; Dehydroepiandrosterone/deficiency ; Glucocorticoids/therapeutic use ; Humans ; Hydrocortisone/metabolism ; Quality of Life
Chemical Substances	Glucocorticoids ; Dehydroepiandrosterone (459AG36T1B) ; Adrenocorticotropic Hormone (9002-60-2) ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2008-11-12
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Intramural ; Review
ZDB-ID	2272017-0
ISSN	1752-2978 ; 1752-296X
ISSN (online)	1752-2978
ISSN	1752-296X
DOI	10.1097/MED.0b013e328338f608
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Article ; Online: Drugs and pheochromocytoma--don't be fooled by every elevated metanephrine.

Neary, Nicola M / King, Kathryn S / Pacak, Karel

The New England journal of medicine

2011 Volume 364, Issue 23, Page(s) 2268–2270

MeSH term(s)	Adrenal Gland Neoplasms/blood ; Adrenal Gland Neoplasms/diagnosis ; Biomarkers, Tumor/blood ; Cyclohexanols/pharmacology ; Female ; Humans ; Metanephrine/blood ; Middle Aged ; Mutation ; Normetanephrine/blood ; Pheochromocytoma/blood ; Pheochromocytoma/diagnosis ; Serotonin Uptake Inhibitors/pharmacology ; Succinate Dehydrogenase/genetics ; Venlafaxine Hydrochloride
Chemical Substances	Biomarkers, Tumor ; Cyclohexanols ; Serotonin Uptake Inhibitors ; Normetanephrine (0J45DE6B88) ; Metanephrine (5001-33-2) ; Venlafaxine Hydrochloride (7D7RX5A8MO) ; SDHB protein, human (EC 1.3.5.1) ; Succinate Dehydrogenase (EC 1.3.99.1)
Language	English
Publishing date	2011-09-19
Publishing country	United States
Document type	Case Reports ; Letter ; Research Support, N.I.H., Intramural
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc1101502#SA1
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Article ; Online: Management of hypertriglyceridaemia-induced acute pancreatitis in pregnancy.

Amin, Tejal / Poon, Leona C Y / Teoh, T G / Moorthy, K / Robinson, Stephen / Neary, Nicola / Valabhji, Jonathan

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

2015 Volume 28, Issue 8, Page(s) 954–958

Abstract: Introduction: Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 and 7 in 10 000 pregnancies and is higher in the third trimester. The commonest causes in pregnancy include gallstones, alcohol and ... ...

Abstract	Introduction: Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 and 7 in 10 000 pregnancies and is higher in the third trimester. The commonest causes in pregnancy include gallstones, alcohol and hypertriglyceridaemia. Non-gallstone pancreatitis is associated with more complications and poorer outcome with hypertriglyceridaemia-induced acute pancreatitis having mortality rates ranging from 7.5 to 9.0% and 10.0 to 17.5% for mother and foetus, respectively. Case history: A 40-year-old para 4 woman, who presented at 15(+4) weeks' gestation, was diagnosed with acute pancreatitis. Past medical history included Graves' disease and hypertriglyceridaemia. Fenofibrate was discontinued immediately after discovery of the pregnancy. Initial investigations showed elevated amylase (475.0 µ/L) and triglycerides (46.6 mmol/L). Imaging revealed an inflamed pancreas without evidence of biliary obstruction/gallstones hence confirming the diagnosis of hypertriglyceridaemia-induced acute pancreatitis. Laboratory tests gradually improved (triglyceride 5.2 mmol/L on day 17). On day 18, ultrasound confirmed foetal demise (18(+1) weeks) and a hysterotomy was performed as she had had four previous caesarean sections. Conclusion: Management of acute pancreatitis in pregnancy requires a multi-disciplinary approach. Hypertriglyceridaemia-induced acute pancreatitis has poor outcomes when diagnosed in early pregnancy. Identifying those at risk pre-pregnancy and antenatally can allow close monitoring through pregnancy to optimise care.
MeSH term(s)	Adult ; Female ; Fetal Death ; Humans ; Hypertriglyceridemia/complications ; Pancreatitis/diagnosis ; Pancreatitis/etiology ; Pancreatitis/therapy ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/etiology ; Pregnancy Complications/therapy
Language	English
Publishing date	2015-05
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2077261-0
ISSN	1476-4954 ; 1057-0802 ; 1476-7058
ISSN (online)	1476-4954
ISSN	1057-0802 ; 1476-7058
DOI	10.3109/14767058.2014.939064
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Zs.A 3510: Show issues

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Article: Successful fertility restoration after allogeneic hematopoietic stem cell transplantation.

Gharwan, Helen / Neary, Nicola M / Link, Mary / Hsieh, Matthew M / Fitzhugh, Courtney D / Sherins, Richard J / Tisdale, John F

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2014 Volume 20, Issue 9, Page(s) e157–61

Abstract: Objective: Myeloablative conditioning regimens given prior to hematopoietic stem cell transplantation (HSCT) frequently cause permanent sterility in men. In patients with sickle cell disease (SCD) we use a nonmyeloablative regimen with sirolimus, ... ...

Abstract	Objective: Myeloablative conditioning regimens given prior to hematopoietic stem cell transplantation (HSCT) frequently cause permanent sterility in men. In patients with sickle cell disease (SCD) we use a nonmyeloablative regimen with sirolimus, alemtuzumab, and low-dose total-body irradiation (300 centigrays) with gonadal shielding preceding allogeneic HSCT. We report here the restoration of azoospermia in a patient with SCD after allogeneic HSCT. We discuss the impact of our patient's underlying chronic medical conditions and the therapies he had received (frequent blood transfusions, iron chelating drugs, ribavirin, hydroxyurea, opioids), as well as the impact of the nonmyeloablative conditioning regimen on male gonadal function, and we review the literature on this topic. Methods: We determined the patient's reproductive hormonal values and his semen parameters before, during, and after HSCT and infertility treatment. In addition, we routinely measured his serum laboratory parameters pertinent to SCD and infertility, such as iron and ferritin levels. A karyotype analysis was performed to assess the potential presence of Klinefelter syndrome. Finally, imaging studies of the patient's brain and testes were done to rule out further underlying pathology. Results: A 42-year-old man with SCD, transfusional iron overload, and hepatitis C underwent a nonmyeloablative allogeneic HSCT. One year later he desired to father a child but was found to be azoospermic in the context of hypogonadotropic hypogonadism. Restoration of fertility was attempted with human chorionic gonadotropin (2,000 IU) plus human menopausal gonadotropin (75 IU follicle-stimulating hormone) injected subcutaneously 3 times weekly. Within 6 months of treatment, the patient's serum calculated free testosterone value normalized, and his sperm count and sperm motility improved. After 10 months, he successfully initiated a pregnancy through intercourse. The pregnancy was uncomplicated, and a healthy daughter was delivered naturally at term. Conclusion: Despite exposure to several gonadotoxins, transfusional iron overload and nonmyeloablative conditioning with radiation causing severe testicular atrophy suggesting extensive damage to seminiferous tubules and possibly Leydig cells, gonadotropins were efficacious in restoring our patient's reproductive capability.
Language	English
Publishing date	2014-06-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.4158/EP13474.CR
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Zs.A 5034: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Appetite regulation: from the gut to the hypothalamus.

Neary, Nicola Marguerite / Goldstone, Anthony Peter / Bloom, Stephen Robert

Clinical endocrinology

2004 Volume 60, Issue 2, Page(s) 153–160

MeSH term(s)	Adipose Tissue/metabolism ; Animals ; Appetite Regulation/physiology ; Brain Stem/metabolism ; Female ; Humans ; Hypothalamus/metabolism ; Insulin/metabolism ; Intestinal Mucosa/metabolism ; Leptin/metabolism ; Male ; Neuropeptides/metabolism ; Obesity/drug therapy ; Obesity/metabolism ; Obesity/surgery ; Peptide Hormones/metabolism
Chemical Substances	Insulin ; Leptin ; Neuropeptides ; Peptide Hormones
Language	English
Publishing date	2004-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1046/j.1365-2265.2003.01839.x
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Zs.A 814: Show issues

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Article ; Online: Development and treatment of tertiary hyperparathyroidism in patients with pseudohypoparathyroidism type 1B.

Neary, Nicola M / El-Maouche, Diala / Hopkins, Rachel / Libutti, Steven K / Moses, Arnold M / Weinstein, Lee S

The Journal of clinical endocrinology and metabolism

2012 Volume 97, Issue 9, Page(s) 3025–3030

Abstract: Context: Pseudohypoparathyroidism type 1B (PHP1B) patients have PTH resistance at the renal proximal tubule and develop hypocalcemia and secondary hyperparathyroidism. Hyperparathyroid bone disease also develops in some patients. PHP1B patients are at ... ...

Abstract	Context: Pseudohypoparathyroidism type 1B (PHP1B) patients have PTH resistance at the renal proximal tubule and develop hypocalcemia and secondary hyperparathyroidism. Hyperparathyroid bone disease also develops in some patients. PHP1B patients are at theoretical risk of developing tertiary hyperparathyroidism. Setting: Patients were studied in a clinical research center. Patients: Five female PHP1B patients presented with hypercalcemia and elevated PTH. Intervention: Patients either underwent parathyroidectomy (n = 4) or received cinacalcet (n = 1). Main outcome measures: Serum calcium and PTH were serially measured before and after intervention. Results: Five PHP1B patients developed concomitantly elevated serum calcium and PTH levels (range, 235-864 ng/liter) requiring termination of calcium and vitamin D therapy (time after diagnosis, 21-42 yr; median, 34 yr), consistent with tertiary hyperparathyroidism. Four patients underwent parathyroidectomy with removal of one (n = 2) or two (n = 2) enlarged parathyroid glands. Calcium and vitamin D therapy was reinstituted postoperatively, and at 93-month median follow-up, PTH levels ranged between 56 and 182 (normal, <87) ng/liter. One patient was treated with cinacalcet, resulting in resolution of hypercalcemia. Conclusions: PHP1B patients are at risk of developing tertiary hyperparathyroidism and/or hyperparathyroid bone disease and should therefore be treated with sufficient doses of calcium and vitamin D to achieve serum calcium and PTH levels within or as close to the normal range as possible. Surgery is the treatment of choice in this setting. Cinacalcet may be a useful alternative in those who do not undergo surgery.
MeSH term(s)	Adolescent ; Age of Onset ; Calcitriol/therapeutic use ; Calcium/therapeutic use ; Child, Preschool ; Disease Progression ; Ergocalciferols/therapeutic use ; Female ; Humans ; Hyperparathyroidism, Secondary/complications ; Hyperparathyroidism, Secondary/genetics ; Hypocalcemia/etiology ; Male ; Middle Aged ; Muscular Diseases/etiology ; Osteitis Fibrosa Cystica/etiology ; Parathyroid Glands/surgery ; Parathyroid Hormone/blood ; Parathyroidectomy ; Pseudohypoparathyroidism/etiology ; Pseudohypoparathyroidism/genetics ; Seizures/etiology ; Syntaxin 16/genetics ; Young Adult ; Pseudohypoparathyroidism
Chemical Substances	Ergocalciferols ; Parathyroid Hormone ; STX16 protein, human ; Syntaxin 16 ; Calcitriol (FXC9231JVH) ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2012-06-26
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, N.I.H., Intramural
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2012-1655
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Article ; Online: Health-related quality of life for everolimus versus placebo in patients with advanced, non-functional, well-differentiated gastrointestinal or lung neuroendocrine tumours (RADIANT-4): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.

Pavel, Marianne E / Singh, Simron / Strosberg, Jonathan R / Bubuteishvili-Pacaud, Lida / Degtyarev, Evgeny / Neary, Maureen P / Carnaghi, Carlo / Tomasek, Jiri / Wolin, Edward / Raderer, Markus / Lahner, Harald / Valle, Juan W / Pommier, Rodney / Van Cutsem, Eric / Tesselaar, Margot E T / Fave, Gianfranco Delle / Buzzoni, Roberto / Hunger, Matthias / Eriksson, Jennifer /

Cella, David / Ricci, Jean-François / Fazio, Nicola / Kulke, Matthew H / Yao, James C

The Lancet. Oncology

2017 Volume 18, Issue 10, Page(s) 1411–1422

Abstract: Background: In the phase 3 RADIANT-4 trial, everolimus increased progression-free survival compared with placebo in patients with advanced, progressive, non-functional, well-differentiated gastrointestinal or lung neuroendocrine tumours (NETs). We now ... ...

Abstract	Background: In the phase 3 RADIANT-4 trial, everolimus increased progression-free survival compared with placebo in patients with advanced, progressive, non-functional, well-differentiated gastrointestinal or lung neuroendocrine tumours (NETs). We now report the health-related quality of life (HRQOL) secondary endpoint. Methods: RADIANT-4 is a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial done in 97 centres in 25 countries worldwide. Adults (aged ≥18 years) were eligible for the study if they had pathologically confirmed, advanced (unresectable or metastatic), non-functional, well-differentiated (grade 1 or 2) NETs of lung or gastrointestinal origin. Patients were randomly allocated (2:1) using block randomisation (block size of three) by an interactive voice response system to receive oral everolimus (10 mg per day) or placebo, both with best supportive care, with stratification by tumour origin, WHO performance status, and previous somatostatin analogue treatment. HRQOL was assessed with the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at baseline (visit 2, day 1), every 8 weeks (± 1 week) during the study for the first 12 months after randomisation, and every 12 weeks thereafter until study drug discontinuation. The primary endpoint, reported previously, was progression-free survival assessed by central review; HRQOL was a prespecified secondary endpoint. The prespecified secondary outcome measure was time to definitive deterioration (≥7 points) in FACT-G total score. Analyses were done on the full analysis set, consisting of all randomised patients, by intention to treat. Only data obtained while receiving the randomly allocated treatment were included in this analysis. Enrolment for RADIANT-4 was completed on Aug 23, 2013, but the trial is ongoing pending final analysis of the key secondary endpoint of overall survival. This trial is registered with ClinicalTrials.gov, number NCT01524783. Findings: Between April 3, 2012, and Aug 23, 2013, 302 patients were enrolled; 205 were randomly allocated everolimus and 97 were assigned placebo. At baseline, 193 (94%) of 205 patients assigned everolimus and 95 (98%) of 97 allocated placebo had completed either fully or partly the FACT-G questionnaire; at week 48, 70 (83%) of 84 patients assigned everolimus and 22 (85%) of 26 allocated placebo completed FACT-G. Median time to definitive deterioration in FACT-G total score was 11·27 months (95% CI 9·27-19·35) with everolimus and 9·23 months (5·52-not estimable) with placebo (adjusted hazard ratio 0·81, 95% CI 0·55-1·21; log-rank p=0·31). Interpretation: HRQOL was maintained for patients with advanced, non-functional, gastrointestinal or lung NETs, with no relevant differences noted between the everolimus and placebo groups. In view of the previous RADIANT-4 findings of longer progression-free survival with everolimus, our findings suggest that everolimus delays disease progression while preserving overall HRQOL, even with the usual toxic effects related to active targeted drug treatment for cancer. Funding: Novartis Pharmaceuticals.
MeSH term(s)	Adult ; Aged ; Disease-Free Survival ; Double-Blind Method ; Everolimus/adverse effects ; Everolimus/therapeutic use ; Female ; Gastrointestinal Neoplasms/drug therapy ; Gastrointestinal Neoplasms/mortality ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/psychology ; Humans ; Internationality ; Lung Neoplasms/drug therapy ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology ; Lung Neoplasms/psychology ; Male ; Middle Aged ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Neuroendocrine Tumors/drug therapy ; Neuroendocrine Tumors/mortality ; Neuroendocrine Tumors/pathology ; Neuroendocrine Tumors/psychology ; Placebos/therapeutic use ; Prognosis ; Proportional Hazards Models ; Quality of Life ; Risk Assessment ; Survival Analysis ; Treatment Outcome
Chemical Substances	Placebos ; Everolimus (9HW64Q8G6G)
Language	English
Publishing date	2017-08-30
Publishing country	England
Document type	Clinical Trial, Phase III ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2049730-1
ISSN	1474-5488 ; 1470-2045
ISSN (online)	1474-5488
ISSN	1470-2045
DOI	10.1016/S1470-2045(17)30471-0
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Zs.A 5696: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: The effect of dietary glycemic index on weight maintenance in overweight subjects: a pilot study.

Philippou, Elena / Neary, Nicola M / Chaudhri, Owais / Brynes, Audrey E / Dornhorst, Anne / Leeds, Anthony R / Hickson, Mary / Frost, Gary S

Obesity (Silver Spring, Md.)

2009 Volume 17, Issue 2, Page(s) 396–401

Abstract: Evidence suggests that a low-glycemic index (LGI) diet has a satiating effect and thus may enhance weight maintenance following weight loss. This study was conducted at Hammersmith Hospital, London, UK, and assessed the effect of altering diet GI on ... ...

Abstract	Evidence suggests that a low-glycemic index (LGI) diet has a satiating effect and thus may enhance weight maintenance following weight loss. This study was conducted at Hammersmith Hospital, London, UK, and assessed the effect of altering diet GI on weight-loss maintenance. It consisted of a weight-loss phase and a 4-month randomized weight maintenance phase. Subjects were seen monthly to assess dietary compliance and anthropometrics. Appetite was assessed bimonthly by visual analogue scales while meal challenge postprandial insulin and glucose concentrations were assessed before and after the intervention. Following a median weight loss of 6.1 (interquartile range: 5.2-7.1) % body weight, subjects were randomized to a high-glycemic index (HGI) (n = 19) or LGI (n = 23) diet. Dietary composition differed only in GI (HGI group: 63.7 +/- 9.4; LGI group: 49.7 +/- 5.7, P < 0.001) and glycemic load (HGI group: 136.8 +/- 56.3; LGI group: 89.7 +/- 27.5, P < 0.001). Groups did not differ in body weight (weight change over 4 months, HGI group: 0.3 +/- 1.9 kg; LGI group: -0.7 +/- 2.9 kg, P = 0.3) or other anthropometric measurements. This pilot study suggests that in the setting of healthy eating, changing the diet GI does not appear to significantly affect weight maintenance.
MeSH term(s)	Adolescent ; Adult ; Aged ; Appetite/physiology ; Body Weight/physiology ; Diet ; Eating/physiology ; Glycemic Index ; Humans ; Middle Aged ; Obesity/physiopathology ; Overweight/physiopathology ; Pain Measurement ; Pilot Projects ; Weight Loss/physiology ; Young Adult
Language	English
Publishing date	2009-02
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2230457-5
ISSN	1930-739X ; 1930-7381 ; 1071-7323
ISSN (online)	1930-739X
ISSN	1930-7381 ; 1071-7323
DOI	10.1038/oby.2008.533
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Article ; Online: Hypercortisolism is associated with increased coronary arterial atherosclerosis: analysis of noninvasive coronary angiography using multidetector computerized tomography.

Neary, Nicola M / Booker, O Julian / Abel, Brent S / Matta, Jatin R / Muldoon, Nancy / Sinaii, Ninet / Pettigrew, Roderic I / Nieman, Lynnette K / Gharib, Ahmed M

The Journal of clinical endocrinology and metabolism

2013 Volume 98, Issue 5, Page(s) 2045–2052

Abstract: Background: Observational studies show that glucocorticoid therapy and the endogenous hypercortisolism of Cushing's syndrome (CS) are associated with increased rates of cardiovascular morbidity and mortality. However, the causes of these findings remain ...

Abstract	Background: Observational studies show that glucocorticoid therapy and the endogenous hypercortisolism of Cushing's syndrome (CS) are associated with increased rates of cardiovascular morbidity and mortality. However, the causes of these findings remain largely unknown. Objective: To determine whether CS patients have increased coronary atherosclerosis. Design: A prospective case-control study was performed. Setting: Subjects were evaulated in a clinical research center. Subjects: Fifteen consecutive patients with ACTH-dependent CS, 14 due to an ectopic source and 1 due to pituitary Cushing's disease were recruited. Eleven patients were studied when hypercortisolemic; 4 patients were eucortisolemic due to medication (3) or cyclic hypercortisolism (1). Fifteen control subjects with at least one risk factor for cardiac disease were matched 1:1 for age, sex, and body mass index. Primary outcome variables: Agatston score a measure of calcified plaque and non-calcified coronary plaque volume were quantified using a multidetector CT (MDCT) coronary angiogram scan. Additional variables included fasting lipids, blood pressure, history of hypertension or diabetes, and 24-hour urine free cortisol excretion. Results: CS patients had significantly greater noncalcified plaque volume and Agatston score (noncalcified plaque volume [mm(3)] median [interquartile ranges]: CS 49.5 [31.4, 102.5], controls 17.9 [2.6, 25.3], P < .001; Agatston score: CS 70.6 [0, 253.1], controls 0 [0, 7.6]; P < .05). CS patients had higher systolic and diastolic blood pressures than controls (systolic: CS 143 mm Hg [135, 173]; controls, 134 [123, 136], P < .02; diastolic CS: 86 [80, 99], controls, 76 [72, 84], P < .05). Conclusions: Increased coronary calcifications and noncalcified coronary plaque volumes are present in patients with active or previous hypercortisolism. Increased atherosclerosis may contribute to the increased rates of cardiovascular morbidity and mortality in patients with glucocorticoid excess.
MeSH term(s)	Adult ; Aged ; Atherosclerosis/etiology ; Case-Control Studies ; Cohort Studies ; Coronary Angiography ; Coronary Artery Disease/etiology ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/pathology ; Cushing Syndrome/diagnostic imaging ; Cushing Syndrome/pathology ; Cushing Syndrome/physiopathology ; Cushing Syndrome/urine ; Female ; Humans ; Hydrocortisone/urine ; Hypertension/etiology ; Male ; Middle Aged ; Plaque, Atherosclerotic/etiology ; Prospective Studies ; Severity of Illness Index ; Tomography, X-Ray Computed ; Vascular Calcification/etiology
Chemical Substances	Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2013-04-04
Publishing country	United States
Document type	Controlled Clinical Trial ; Journal Article ; Research Support, N.I.H., Intramural
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2012-3754
Database	MEDical Literature Analysis and Retrieval System OnLINE

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