Whitworth JA, Williamson PM, Mangos G, Kelly JJ. Cardiovascular consequences of cortisol excess. Vasc Health Risk Manag. 2005;1:291-299. Abstract
Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:1526-1540. Abstract
Biller BM, Grossman AB, Stewart PM, et al. Treatment of adrenocorticotropin-dependent Cushing's syndrome: a consensus statement. J Clin Endocrinol Metab. 2008;93:2454-2462. Abstract
Swearingen B, Biller BM, Barker FG 2nd, et al. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med. 1999;139:821-824.
Feelders RA, Pulgar SJ, Kempel A, Pereira AM. The burden of Cushing's disease: clinical and health-related quality of life aspects. Eur J Endocrinol. 2012;167:311-326. Abstract
Tritos NA, Biller BM, Swearingen B. Management of Cushing disease. Nat Rev Endocrinol. 2011;7:279-289. Abstract
Alexandraki KI, Kaltsas GA, Isidori AM, et al. Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study. Eur J Endocrinol. 2013;168:639-648. Abstract
Hameed N, Yedinak CG, Brzana J, et al. Remission rate after transsphenoidal surgery in patients with pathologically confirmed Cushing's disease, the role of cortisol, ACTH assessment, and immediate reoperation: a large single center experience. Pituitary. 2012. Abstract
Hassan-Smith ZK, Sherlock M, Reulen RC, et al. Outcome of Cushing's disease following transsphenoidal surgery in a single centre over 20 years. J Clin Endocrinol Metab.2012; 97:1194-1201. Abstract
Honegger J, Schmalisch K, Beuschlein F, et al. Contemporary microsurgical concept for the treatment of Cushing's disease: endocrine outcome in 83 consecutive patients. Clin Endocrinol (Oxf). 2012:560-567. Abstract
Roelfsema F, Biermasz NR, Pereira AM. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. Pituitary. 2012;15:71-83. Abstract
Ram Z, Nieman LK, Cutler GB Jr, Chrousos GP, Doppman JL, Oldfield EH. Early repeat surgery for persistent Cushing's disease. J Neurosurg. 1994;80:37-45. Abstract
Sheth SA, Bourne SK, Tritos NA, Swearingen B. Neurosurgical treatment of Cushing disease. Neurosurg Clin N Am. 2012;23:639- 651. Abstract
Chow JT, Thompson GB, Grant CS, Farley DR, Richards ML, Young WF Jr. Bilateral laparoscopic adrenalectomy for corticotrophin- dependent Cushing's syndrome: a review of the Mayo Clinic experience. Clin Endocrinol (Oxf). 2008;68:513-519. Abstract
Pugliese R, Boniardi M, de Carli S, et al. Laparoscopic bilateral simultaneous adrenalectomy: results of 11 operations. J Laparoendosc Adv Surg Tech. 2008;18:588-592. Abstract
Assié G, Bahurel H, Coste J, et al. Corticotroph tumor progression after adrenalectomy in Cushing's disease: a reappraisal of Nelson's syndrome. J Clin Endocrinol Metab. 2007;92:172-179. Abstract
Kobayashi T, Kida Y, Mori Y. Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg. 2002;97:422-428. Abstract
Castinetti F, Nagai M, Dufour H, et al. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease. Eur J Endocrinol. 2007;156:91-98. Abstract
Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma knife surgery for Cushing's disease. J Neurosurg. 2007;106;980-987. Abstract
Petit JH, Biller BM, Yock TI, et al. Proton stereotactic radiotherapy for persistent adrenocorticotropin-producing adenomas. J Clin Endocrinol Metab. 2008;93:393-399. Abstract
Feelders RA, Hofland, LJ. Medical treatment of Cushing's disease. J Clin Endocrinol Metab. 2013;98:425-438. Abstract
Tritos NA, Biller BM. Advances in medical therapies for Cushing's syndrome. Discov Med. 2012;13:171-179. Abstract
Engelhardt D, Weber MM. Therapy of Cushing's syndrome with steroid biosynthesis inhibitors. J Steroid Biochem Mol Biol. 1994;49:261-267. Abstract
Lewis JH, Zimmerman HJ, Benson GD, Ishak KG. Hepatic injury associated with ketoconazole therapy. Analysis of 33 cases. Gastroenterology. 1984;86:503-513. Abstract
Verhelst JA, Trainer PJ, Howlett TA, et al. Short and long-term responses to metyrapone in the medical management of 91 patients with Cushing's syndrome. Clin Endocrinol (Oxf). 1991;35:169-178. Abstract
Luton JP, Mahoudeau JA, Bouchard P, et al. Treatment of Cushing's disease by O,p'DDD. Survey of 62 cases. N Engl J Med. 1979;300:459-464. Abstract
Baudry C, Coste J, Bou Khalil R, et al. Efficiency and tolerance of mitotane in Cushing's disease in 76 patients from a single center. Eur J Endocrinol. 2012;167:473-481. Abstract
Schulte HM, Benker G, Reinwein D, Sippell WG, Allolio B. Infusion of low dose etomidate: correction of hypercortisolemia in patients with Cushing's syndrome and dose-response relationship in normal subjects. J Clin Endocrinol Metab. 1990;70:1426-1430. Abstract
Pivonello R, De Martino MC, Cappabianca P, et al. The medical treatment of Cushing's disease: effectiveness of chronic treatment with the dopamine agonist cabergoline in patients unsuccessfully treated by surgery. J Clin Endocrinol Metab. 2009;94:223-230. Abstract
Godbout A, Manavela M, Danilowicz K, Beauregard H, Bruno OD, Lacroix A. Cabergoline monotherapy in the long-term treatment of Cushing's disease. Eur J Endocrinol. 2010;163:709-716. Abstract
Rasmussen VG, Østergaard K, Dupont E, Poulsen SH. The risk of valvular regurgitation in patients with Parkinson's disease treated with dopamine receptor agonists. Mov Disord. 2011;26:801-806. Abstract
Boguszewski CL, dos Santos CM, Sakamoto KS, Marini LC, de Souza AM, Azevedo M. A comparison of cabergoline and bromocriptine on the risk of valvular heart disease in patients with prolactinomas. Pituitary. 2012;15:44-49. Abstract
Colao A, Petersenn S, Newell-Price J, et al. A 12-month phase 3 study of pasireotide in Cushing's disease. N Engl J Med. 2012;366:914-924. Abstract
Fleseriu M, Biller BM, Findling JW, Molitch ME, Schteingart DE, Gross C. Mifepristone, a glucocorticoid receptor antagonist, produces clinical and metabolic benefits in patients with Cushing's syndrome. J Clin Endocrinol Metab. 2012;97:2039-2049. Abstract
Feelders RA, de Bruin C, Pereira AM, et al. Pasireotide alone or with cabergoline and ketoconazole in Cushing’s disease. N Engl J Med. 2010;362:1846-1848. Abstract
Castinetti F, Fassnacht M, Johanssen S, et al. Merits and pitfalls of mifepristone in Cushing's syndrome. Eur J Endocrinol. 2009;160:1003-1010. Abstract
DiMatteo MR. Enhancing patient adherence to medical recommendations. JAMA. 1994;27:79. Abstract
Gadkari AS, McHorney CA. Medication nonfulfillment rates and reasons: narrative systemic review. Curr Med Res Opin. 2010;26:683-705. Abstract
Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157:785-795. Abstract
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23:1296-1310. Abstract

CME/CE

Cushing Disease: A Multidisciplinary Treatment Update

Authors: Laurence Katznelson, MD; Brooke Swearingen, MD; Nicholas Tritos, MD; Susan Cornell, PharmD, CDE; Rita Pach, RN, MSN
CME/CE Released: 6/26/2013
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 6/26/2014

Target Audience and Goal Statement

This activity is intended for endocrinologists, primary care physicians, nurses, nurse practitioners, and pharmacists.

The goal of this activity is to review the diagnosis and treatment of Cushing disease from a multidisciplinary perspective.

Upon completion of this activity, participants will be able to:

Outline the rationale for a multidisciplinary approach to the diagnosis and treatment of patients with Cushing disease
Review the safety and efficacy of current management strategies for patients with Cushing disease
Describe the diagnostic workup for Cushing disease and the reasons why timely diagnosis and treatment are important

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Authors

Laurence Katznelson, MD

Professor of Medicine and Neurosurgery, Stanford University; Medical Director, Pituitary Center, Stanford Hospital and Clinics, Stanford, California

Disclosures

Disclosure: Laurence Katznelson, MD, has disclosed the following relevant financial relationships:
Received grants for clinical research from: Corcept Therapeutics Inc.; Novartis Pharmaceuticals Corporation

Dr Katznelson does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Katznelson does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Brooke Swearingen, MD

Associate Professor of Neurosurgery, Harvard Medical School; Associate Visiting Neurosurgeon, Massachusetts General Hospital, Boston, Massachusetts

Disclosures

Disclosure: Brooke Swearingen, MD, has disclosed the following relevant financial relationships: Served as an advisor or consultant for: Novartis Pharmaceuticals Corporation
Owns stock, stock options or bonds from: Novartis Pharmaceuticals Corporation; Pfizer Inc; Amgen Inc; Roche

Dr Swearingen does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Swearingen does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Nicholas Tritos, MD

Assistant Professor of Medicine, Harvard Medical School; Staff, Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts

Disclosures

Disclosure: Nicholas Tritos, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Corcept Therapeutics Inc; Pfizer Inc
Received grants for clinical research from: Pfizer Inc; Ipsen

Dr Tritos does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Tritos does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Susan Cornell, PharmD, CDE

Associate Professor, Pharmacy Practice, Midwestern University-Chicago, Downers Grove, Illinois; Clinical Pharmacist/Certified Diabetes Educator, DuPage Community Clinic, Wheaton, Illinois

Disclosures

Disclosure: Susan Cornell, PharmD, CDE, has disclosed the following relevant relationships:
Served as a speaker or member of a speakers bureau for: Johnson & Johnson Diabetes Institute

Dr Cornell does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Cornell does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Rita Pach, RN, MSN

Nurse, Johns Hopkins Pituitary Center, Baltimore, Maryland

Disclosures

Participation by Mrs Pach in the development of this product does not constitute or imply endorsement by the Johns Hopkins University or the Johns Hopkins Hospital and Health System.
Disclosure: Rita Pach, RN, has disclosed no relevant financial relationships.

Mrs Pach does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Mrs Pach does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editors

Kristin M. Richardson

Group Scientific Director, Medscape, LLC

Disclosures

Disclosure: Kristin M. Richardson has disclosed no relevant financial relationships.

David Modrak, PhD

Freelance editor, Montville, New Jersey

Disclosures

Disclosure: David Modrak, PhD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Nurse Planner

Laurie E. Scudder, DNP, NP

Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC

Disclosures

Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Contact This Provider

For Nurses

Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Awarded 0.75 contact hour(s) of continuing nursing education for RNs and APNs; 0.25 contact hours are in the area of pharmacology.

Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.

Contact This Provider

For Pharmacists

Medscape, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Medscape designates this continuing education activity for 0.75 contact hour(s) (0.075 CEUs) (Universal Activity Number 0461-0000-13-027-H01-P).

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

From Medscape Education Diabetes & Endocrinology

CME/CE

Cushing Disease: A Multidisciplinary Treatment Update

Authors: Laurence Katznelson, MD; Brooke Swearingen, MD; Nicholas Tritos, MD; Susan Cornell, PharmD, CDE; Rita Pach, RN, MSNFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME/CE Released: 6/26/2013

Valid for credit through: 6/26/2014

processing....

Contents of This CME Activity

All sections of this activity are required for credit.

Section 1. Cushing Disease: An Introduction

Dr Laurence Katznelson reviews the basics of this rare disease.
Laurence Katznelson, MD

Section 2. Surgical Approaches to Cushing Disease

Dr Brooke Swearingen reviews the surgical treatment of Cushing disease.
Brooke Swearingen, MD

Section 3. Medical Therapy for Cushing Disease

Dr Nicholas Tritos reviews medical options for the treatment of Cushing disease.
Nicholas Tritos, MD

Section 4. Cushing Disease: A Nursing Perspective

Rita Pach, RN, MSN, discusses how nurses can be part of a multidisciplinary team treating patients with Cushing disease.
Rita Pach, RN, MSN

Section 5. Medical Therapies for Cushing Disease: Improving Medication Adherence

Susan Cornell, PharmD, CDE, reviews medication adherence in relation to Cushing disease.
Susan Cornell, PharmD, CDE

Page 1 of 6

Cushing Disease: An Introduction

CME/CE Information

Print
Like Tweet

References

Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Authors

Laurence Katznelson, MD

Brooke Swearingen, MD

Nicholas Tritos, MD

Susan Cornell, PharmD, CDE

Rita Pach, RN, MSN

Editors

Kristin M. Richardson

David Modrak, PhD

CME Reviewer(s)

Nafeez Zawahir, MD

Nurse Planner

Laurie E. Scudder, DNP, NP

CME/CE

Cushing Disease: A Multidisciplinary Treatment Update

Target Audience and Goal Statement

Disclosures

Authors

Laurence Katznelson, MD

Brooke Swearingen, MD

Nicholas Tritos, MD

Susan Cornell, PharmD, CDE

Rita Pach, RN, MSN

Editors

Kristin M. Richardson

David Modrak, PhD

CME Reviewer(s)

Nafeez Zawahir, MD

Nurse Planner

Laurie E. Scudder, DNP, NP

Accreditation Statements

For Physicians

For Nurses

For Pharmacists

Instructions for Participation and Credit

Cushing Disease: A Multidisciplinary Treatment Update

Contents of This CME Activity