title: Clinical management of critically ill patients with Cushing's disease due to ACTH-secreting pituitary macroadenomas: effectiveness of presurgical treatment with pasireotide.
abstract: The management of critically ill Cushing's disease (CD) patients is extremely challenging. Pasireotide is indicated for the treatment of CD patients when pituitary surgery is unfeasible or has not been curative, but no data are available about the use of this drug as pre-operative treatment in critically ill patients. We report the effects of presurgical pasireotide therapy in CD patients in whom hypercortisolism caused life-threatening hypokalemia, alkalosis, and cardio-respiratory complications precluding surgical approach. Clinical, biochemical, and radiological data of two critically ill patients with ACTH-secreting pituitary macroadenoma, before and during first-line presurgical pasireotide treatment (600 μg s.c. bid). During the first 21 days of treatment, pasireotide therapy induced a rapid, partial decrease of plasma ACTH, serum cortisol, and urinary free cortisol levels, with the consequent normalization of serum potassium concentration and arterial blood gases parameters, in both the patients. They did not experience unmanageable side effects and underwent endoscopic transsphenoidal surgery after 4 weeks of effective treatment. Pre-operative MRI evaluation did not show pituitary tumor shrinkage. Surgical cure of CD was obtained in the first patient, while debulking allowed the pharmacological control of hypercortisolism in the second case. We suggest that pasireotide can induce a rapid improvement of clinical and metabolic conditions in critically ill CD patients in whom surgical approach is considered hazardous and need to be delayed.
authors: Department of Clinical and Experimental Medicine - Endocrinology Unit, University of Messina, Messina, Italy.
authors: S
authors: S
authors: Cannavo
authors: Department of Clinical and Experimental Medicine - Endocrinology Unit, University of Messina, Messina, Italy.
authors: E
authors: E
authors: Messina
authors: Department of Clinical and Experimental Medicine - Endocrinology Unit, University of Messina, Messina, Italy.
authors: A
authors: A
authors: Albani
authors: Department of Clinical and Experimental Medicine - Endocrinology Unit, University of Messina, Messina, Italy. francesco.ferrau1@gmail.com.
authors: F
authors: F
authors: Ferrau
authors: Department of Human Pathology Gaetano Barresi - Section of Anatomic Pathology, University of Messina, Messina, Italy.
authors: V
authors: V
authors: Barresi
authors: Department of Neuroscience - Neurosurgery Unit, University of Messina, Messina, Italy.
authors: S
authors: S
authors: Priola
authors: Department of Neuroscience - Neurosurgery Unit, University of Messina, Messina, Italy.
authors: F
authors: F
authors: Esposito
authors: Department of Neuroscience - Neurosurgery Unit, University of Messina, Messina, Italy.
authors: F
authors: F
authors: Angileri
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D057234:Preoperative Period; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D013004:Somatostatin; C517782:pasireotide
keywords: ARDS; Cushing’s disease; Hypercortisolism; Pituitary tumors; Somatostatin analogs