Clinical management of patients with Cushing syndrome treated with mifepristone: consensus recommendations.

David R Brown, Honey E East, Bradley S Eilerman, Murray B Gordon, Elizabeth E King, Laura A Knecht, Brandon Salke, Susan L Samson, Kevin C J Yuen, Hanford Yau
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引用次数: 15

Abstract

Background: While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing Syndrome) trial. Mifepristone is a competitive glucocorticoid receptor antagonist and progesterone receptor antagonist that is associated with several treatment effects and adverse events that clinicians need to be aware of when considering its use. The objective of this review was to provide updated clinical management recommendations for patients with CS treated with mifepristone.

Methods: A panel of endocrinologists from the US with extensive experience in treating patients with CS, including with mifepristone, convened as part of a clinical advisory board to develop a consensus on the practical, real-world clinical management of patients on mifepristone.

Results: Comprehensive considerations and recommendations are provided for managing mifepristone-associated effects, including symptoms of cortisol withdrawal, hypokalemia, and change in thyroid function; effects related to its antiprogesterone activity; and rash. Additional management strategies to address concomitant medications and special clinical situations, such as surgery and use in specific populations, are also provided.

Conclusion: Safe and effective use of mifepristone requires clinical judgment and close patient monitoring to ensure optimal clinical outcomes. These consensus recommendations provide useful, practical guidance to clinicians using mifepristone.

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米非司酮治疗库欣综合征患者的临床管理:共识建议。
背景:虽然手术是内源性高皮质醇血症(库欣综合征[CS])患者的一线治疗方法,但正如SEISMIC(米非司酮治疗内源性库欣综合征的疗效和安全性研究)试验所证明的那样,米非司酮已被证明是一种有益的药物治疗选择。米非司酮是一种竞争性糖皮质激素受体拮抗剂和黄体酮受体拮抗剂,与几种治疗效果和不良事件相关,临床医生在考虑使用米非司酮时需要注意。本综述的目的是为使用米非司酮治疗的CS患者提供最新的临床管理建议。方法:来自美国的一组内分泌学家在治疗CS患者(包括米非司酮)方面具有丰富的经验,他们作为临床咨询委员会的一部分召开会议,就米非司酮患者的实际临床管理达成共识。结果:提供了管理米非司酮相关效应的综合考虑和建议,包括皮质醇戒断症状、低钾血症和甲状腺功能改变;与抗孕酮活性有关的作用;和皮疹。还提供了额外的管理策略,以处理伴随用药和特殊临床情况,如手术和在特定人群中使用。结论:安全有效地使用米非司酮需要临床判断和严密的患者监测,以确保最佳的临床效果。这些共识建议为临床医生使用米非司酮提供了有用、实用的指导。
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来源期刊
自引率
0.00%
发文量
7
审稿时长
8 weeks
期刊介绍: Clinical Diabetes and Endocrinology is an open access journal publishing within the field of diabetes and endocrine disease. The journal aims to provide a widely available resource for people working within the field of diabetes and endocrinology, in order to improve the care of people affected by these conditions. The audience includes, but is not limited to, physicians, researchers, nurses, nutritionists, pharmacists, podiatrists, psychologists, epidemiologists, exercise physiologists and health care researchers. Research articles include patient-based research (clinical trials, clinical studies, and others), translational research (translation of basic science to clinical practice, translation of clinical practice to policy and others), as well as epidemiology and health care research. Clinical articles include case reports, case seminars, consensus statements, clinical practice guidelines and evidence-based medicine. Only articles considered to contribute new knowledge to the field will be considered for publication.
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