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Medical treatment of Cushing’s disease with concurrent diabetes mellitus

Cushing’s disease (CD) is a severe endocrine disorder characterized by chronic hypercortisolaemia secondary to an overproduction of adrenocorticotropic hormone (ACTH) by a pituitary adenoma. Cortisol excess impairs normal glucose homeostasis through many pathophysiological mechanisms. The varying de...

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Autores principales: Mehlich, Anna, Bolanowski, Marek, Mehlich, Dawid, Witek, Przemysław
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150952/
https://www.ncbi.nlm.nih.gov/pubmed/37139336
http://dx.doi.org/10.3389/fendo.2023.1174119
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author Mehlich, Anna
Bolanowski, Marek
Mehlich, Dawid
Witek, Przemysław
author_facet Mehlich, Anna
Bolanowski, Marek
Mehlich, Dawid
Witek, Przemysław
author_sort Mehlich, Anna
collection PubMed
description Cushing’s disease (CD) is a severe endocrine disorder characterized by chronic hypercortisolaemia secondary to an overproduction of adrenocorticotropic hormone (ACTH) by a pituitary adenoma. Cortisol excess impairs normal glucose homeostasis through many pathophysiological mechanisms. The varying degrees of glucose intolerance, including impaired fasting glucose, impaired glucose tolerance, and Diabetes Mellitus (DM) are commonly observed in patients with CD and contribute to significant morbidity and mortality. Although definitive surgical treatment of ACTH-secreting tumors remains the most effective therapy to control both cortisol levels and glucose metabolism, nearly one-third of patients present with persistent or recurrent disease and require additional treatments. In recent years, several medical therapies demonstrated prominent clinical efficacy in the management of patients with CD for whom surgery was non-curative or for those who are ineligible to undergo surgical treatment. Cortisol-lowering medications may have different effects on glucose metabolism, partially independent of their role in normalizing hypercortisolaemia. The expanding therapeutic landscape offers new opportunities for the tailored therapy of patients with CD who present with glucose intolerance or DM, however, additional clinical studies are needed to determine the optimal management strategies. In this article, we discuss the pathophysiology of impaired glucose metabolism caused by cortisol excess and review the clinical efficacy of medical therapies of CD, with particular emphasis on their effects on glucose homeostasis.
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spelling pubmed-101509522023-05-02 Medical treatment of Cushing’s disease with concurrent diabetes mellitus Mehlich, Anna Bolanowski, Marek Mehlich, Dawid Witek, Przemysław Front Endocrinol (Lausanne) Endocrinology Cushing’s disease (CD) is a severe endocrine disorder characterized by chronic hypercortisolaemia secondary to an overproduction of adrenocorticotropic hormone (ACTH) by a pituitary adenoma. Cortisol excess impairs normal glucose homeostasis through many pathophysiological mechanisms. The varying degrees of glucose intolerance, including impaired fasting glucose, impaired glucose tolerance, and Diabetes Mellitus (DM) are commonly observed in patients with CD and contribute to significant morbidity and mortality. Although definitive surgical treatment of ACTH-secreting tumors remains the most effective therapy to control both cortisol levels and glucose metabolism, nearly one-third of patients present with persistent or recurrent disease and require additional treatments. In recent years, several medical therapies demonstrated prominent clinical efficacy in the management of patients with CD for whom surgery was non-curative or for those who are ineligible to undergo surgical treatment. Cortisol-lowering medications may have different effects on glucose metabolism, partially independent of their role in normalizing hypercortisolaemia. The expanding therapeutic landscape offers new opportunities for the tailored therapy of patients with CD who present with glucose intolerance or DM, however, additional clinical studies are needed to determine the optimal management strategies. In this article, we discuss the pathophysiology of impaired glucose metabolism caused by cortisol excess and review the clinical efficacy of medical therapies of CD, with particular emphasis on their effects on glucose homeostasis. Frontiers Media S.A. 2023-04-17 /pmc/articles/PMC10150952/ /pubmed/37139336 http://dx.doi.org/10.3389/fendo.2023.1174119 Text en Copyright © 2023 Mehlich, Bolanowski, Mehlich and Witek https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Mehlich, Anna
Bolanowski, Marek
Mehlich, Dawid
Witek, Przemysław
Medical treatment of Cushing’s disease with concurrent diabetes mellitus
title Medical treatment of Cushing’s disease with concurrent diabetes mellitus
title_full Medical treatment of Cushing’s disease with concurrent diabetes mellitus
title_fullStr Medical treatment of Cushing’s disease with concurrent diabetes mellitus
title_full_unstemmed Medical treatment of Cushing’s disease with concurrent diabetes mellitus
title_short Medical treatment of Cushing’s disease with concurrent diabetes mellitus
title_sort medical treatment of cushing’s disease with concurrent diabetes mellitus
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150952/
https://www.ncbi.nlm.nih.gov/pubmed/37139336
http://dx.doi.org/10.3389/fendo.2023.1174119
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