Medical Journal of the Islamic Republic Of Iran
مجله پزشکی جمهوری اسلامی ایران
Med J Islam Repub Iran
Medical Sciences
http://mjiri.iums.ac.ir
2
journal2
1016-1430
2251-6840
8
10.18869/mjiri
14
8888
13
en
jalali
1394
10
1
gregorian
2016
1
1
30
1
online
1
fulltext
en
A survey of clinical practice patterns in diagnosis and management of Cushing\'s disease in Iran
Endocrinology
Endocrinology
Original Research
Original Research
<p dir="ltr" style="text-align: justify;"><strong>Background: </strong>Cushing's disease is the most prevalent cause of endogenous adrenocorticotrophic hormone hypersecretion. The aim of this study was to document the current clinical practice pattern in the management of Cushing's disease by Iranian Endocrinologists to determine their opinions and compare them with the current clinical practice guidelines. </p>
<p dir="ltr" style="text-align: justify;"><strong> Methods</strong>: An eight-item questionnaire dealing with diagnosis, treatment and follow up of patients with Cushing's disease was developed, piloted, and sent to the members of Iranian Endocrinology Society.</p>
<p dir="ltr" style="text-align: justify;"><strong> Results</strong>: Among 90 endocrinologists invited to participate in the survey, 76 replied. Most respondents selected overnight dexamethasone suppression test (ONDST) and assessment of 24-hour urinary free cortisol (UFC) as the best screening tests followed by midnight serum cortisol and midnight salivary cortisol. Classic high dose dexamethasone suppression test and measurement of serum ACTH were selected for localization of the primary lesion by 64.5%. The primary choice of treatment was trans-sphenoidal pituitary surgery (86.8%). For the recurrence of Cushing's disease, the preferred treatment modality was medical therapy followed by bilateral adrenalectomy, and pituitary re-surgery. In case of treatment failure after the first pituitary surgery and ketoconazole treatment, 51% chose bilateral adrenalectomy, while36.8% selected pasireotide only.</p>
<p dir="ltr" style="text-align: justify;"><strong> Conclusion</strong>: ONDST and UFC are two most common tests used to screen an index case with signs and symptoms of hypercortisolism. The primary choice of treatment in Cushing's disease is pituitary surgery. However, medical treatment by ketokonazol is preferred for the recurrences. Pasireotide is the second alternative after bilateral adrenalectomy in case of treatment failure after pituitary surgery and ketoconazole.</p>
Cushing\'s disease, Diagnosis, Management, Clinical Practice.
210
216
http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-966&slc_lang=en&sid=1
Mojtaba
Malek
malekmoj@yahoo.com
200319475328460021420
200319475328460021420
No
Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
Fatemeh
Esfehanian
fesfehanian@sina.tums.ac.ir
200319475328460021421
200319475328460021421
No
Department of Endocrinology, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Atieh
Amouzegar
amouzegar@endocrine.ac.ir
200319475328460021422
200319475328460021422
No
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Farzaneh
Sarvghadi
f.sarvghadi@yahoo.com
200319475328460021423
200319475328460021423
No
Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Zohreh
Moossavi
mosaviz@mums.ac.ir
200319475328460021424
200319475328460021424
No
Endocrine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad R.
Mohajeri-Tehrani
mrmohajeri@tums.ac.ir
200319475328460021425
200319475328460021425
No
Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad E.
Khamseh
khamseh.m@iums.ac.ir
200319475328460021426
200319475328460021426
Yes
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
Alireza
Amirbaigloo
amirbaigloo@razi.tums.ac.ir
200319475328460021427
200319475328460021427
No
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
Ameneh Ebrahim
Valojerdi
ebrahimv86@gmail.com
200319475328460021428
200319475328460021428
No
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.