A Report From Endo 2004

The CSRF exhibited for the 9th year in a row at the annual meeting of the Endocrine Society in New Orleans in June. The booth was staffed by Louise Pace, Karen Campbell, and Patty Sue Neubauer (Beloxi, MS). The focus of this year's conference was "Obesity, Endocrinology and the Future." A booklet, "The Endocrine Society Weighs In-A Handbook on Obesity in America", published primarily for members of the press, did contain at least a mention of Cushing's, but in our minds Cushing's could have been given more serious consideration as a cause of obesity. In the technical sessions, numerous papers mentioned glucocorticoids and Cushing's as secondary causes of obesity. Research is clearly underway to understand weight gain and there is a strong indication that cortisol is involved in the abdominal obesity that is prevalent in the general population. Perhaps future research will benefit those who have or had Cushing's as well.

There were several interesting papers addressing the question of how common Cushing's is in different populations. Dr. Kadioglu (Univ. of Istanbul, Turkey) reported that in screening for Cushing's in 100 obese patients, 11% had Cushing's as determined by an overnight dex test. The Cushing's diagnosis was confirmed by cure after surgery in 9%; the others refused further testing. Further studies will be needed to see if this percentage is applicable to the population in general. In another study, Dr. Nishikawa (Yokohama, Japan) studied 1,020 patients with high blood pressure and found that about 2% had active Cushing's or sub-clinical Cushing's. Dr. Friedman (Charles Drew, Los Angeles) reported that testing of mild and cycling patients continues to be difficult and no one single test at one time point can be used to eliminate Cushing's. Thus, mild and cyclic cases may be more prevalent than previously thought.
Rosiglitasone was first reported as a possible drug treatment for pituitary Cushing's last year. It was encouraging to see other investigators report this year, however results are conflicting. In one study (Dr. Alevizai, Athens Univ.) reported a decrease in ACTH and cortisol in 4 out of 5 patients treated with rosiglitisone who had unsuccessful surgeries or recurrences. Another study (Dr. Ambrosi, Univ. of Milan) reported some patients responded to rosiglitisone with mild clinical improvement, some required dose increases, and some did not respond. Thus, while rosiglitisone may be helpful in some cases, more studies are needed. In another study, the drug Cabergoline (Dr. Pivonello, Fredrico II Univ) proved valuable for 80% of patient's who's pituitary tumors expressed the D2 receptor, however a significant percentage subsequently relapsed. And so, the search continues!

There were many other excellent presentations including well attended Meet the Professor sessions on Cushing's (Dr. Lynnette Nieman, NIH and Dr. Peter Trainer, UK), and a symposium on Cushing's. Dr. James Findling, (St. Luke's, Milwaukee) discussed measurement of prolactin and ACTH during petrosal sinus sampling to account for abnormal venous drainage that can falsely identify patients as ectopic. Dr. Vance (Univ. of Virginia) presented data on the quality of life of Cushing's patients.
You can search the abstracts yourself at http://www.abstracts2view.com/endo/.