Nienke R. Biermasz

MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

BACKGROUNDnCushings syndrome (CS) is characterized by excessive exposure to cortisol, and is associated with both metabolic and behavioral abnormalities. Symptoms improve substantially after biochemical cure, but may persist during long-term remission. The causes for persistent morbidity are probably multi-factorial, including a profound effect of cortisol excess on the brain, a major target area for glucocorticoids.nnnOBJECTIVEnTo review publications evaluating brain characteristics in patients with CS using magnetic resonance imaging (MRI).nnnMETHODSnSystematic review of literature published in PubMed, Embase, Web of Knowledge, and Cochrane databases.nnnRESULTSnNineteen studies using MRI in patients with CS were selected, including studies in patients with active disease, patients in long-term remission, and longitudinal studies, covering a total of 339 unique patients. Patients with active disease showed smaller hippocampal volumes, enlarged ventricles, and cerebral atrophy as well as alterations in neurochemical concentrations and functional activity. After abrogation of cortisol excess, the reversibility of structural and neurochemical alterations was incomplete after long-term remission. MRI findings were related to clinical characteristics (i.e., cortisol levels, duration of exposure to hypercortisolism, current age, age at diagnosis, and triglyceride levels) and behavioral outcome (i.e., cognitive and emotional functioning, mood, and quality of life).nnnCONCLUSIONnPatients with active CS demonstrate brain abnormalities, which only partly recover after biochemical cure, because these still occur even after long-term remission. CS might be considered as a human model of nature that provides a keyhole perspective of the neurotoxic effects of exogenous glucocorticoids on the brain.

Lanreotide Autogel® in the Treatment of Acromegaly:

BackgroundIn acromegaly expert surgery is curative in only about 60% of patients. Postoperative radiation therapy is associated with a high incidence of hypopituitarism and its effect on GH production is slow, so that adjuvant medical treatment becomes of importance in the management of many patients.ObjectiveTo delineate the role of lanreotide Autogel® in the treatment of acromegaly.MethodsSearch of Medline, Embase and Web of Science databases for clinical lanreotide studies in acromegaly.ResultsThe weighted mean of serum GH normalization by Lanreotide Autogel®, based on 10 published clinical studies, was 58% in 370 patients. These patients were mostly switched from other somatostatin analogs. Serum IGF-I concentration normalized in 48% of these patients. Three small studies, with a total of 60 patients, compared the efficacy of octreotide LAR and that of lanreotide Autogel®. The highest dose of lanreotide appeared to be equivalent with 20 mg of octreotide LAR. Observed side effects were comparable with ...