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dc.contributor.authorPapakokkinou, Eleni
dc.date.accessioned2022-04-28T09:51:34Z
dc.date.available2022-04-28T09:51:34Z
dc.identifier.isbn978-91-8009-695-9 (PRINT)
dc.identifier.isbn978-91-8009-696-6 (PDF)
dc.identifier.urihttps://hdl.handle.net/2077/70542
dc.description.abstractCushing’s syndrome (CS) is caused by prolonged exposure to cortisol excess. CS is associated with cardiovascular diseases, infections, and fractures, as well as with cognitive impairment and affective disorders. This thesis, based on four studies, aimed to investigate various aspects of the management of CS: the diagnostic work-up as well as the morbidity after successful treatment. A retrospective analysis on the usefulness of adrenal venous sampling (AVS) in patients with cortisol excess and bilateral adrenal lesions or morphologically normal adrenal glands, showed that AVS contributed to the decision-making of the treatment in two out of ten patients (Paper I). In a cross-sectional study, patients with CS in remission experienced mental fatigue and had impaired executive function, assessed with the self-administrated Mental Fatigue Scale (MFS) and Trail Making Test (TMT), respectively (Paper II). In a nationwide population-based study, excess morbidity was found in patients with pituitary CS (Cushing’s disease, CD). A more than 3-fold increased incidence of stroke, thromboembolism, and sepsis was found even in remission compared to the background population (Paper III). A systematic review and meta-analysis on patients with CD treated with bilateral adrenalectomy showed that every fourth patient developed progression or new onset of a pituitary tumor (Nelson’s syndrome, NS) and every fifth patient received treatment for NS. Also, NS occurred up to four decades after bilateral adrenalectomy (Paper IV). In conclusion, this thesis illustrates that patients with CS have excess morbidity due to stroke, thromboembolism, sepsis as well as cognitive impairment and mental fatigue despite treatment. Also, this thesis highlights the need for life-long follow-up of patients with CS. Despite the major progress achieved in the management of patients with CS, there are still challenges to overcome, both in the diagnostic work-up and treatment.en_US
dc.language.isoengen_US
dc.relation.haspartI. Papakokkinou E, Jakobsson H, Sakinis A, Muth A, Wängberg B, Ehn O, Johannsson G, Ragnarsson O. Adrenal venous sampling in patients with ACTH-independent hypercortisolism. Endocrine. 2019;66(2): 338-348. http://doi.org/10.1007/s12020-019-02038-0en_US
dc.relation.haspartII. Papakokkinou E, Johansson B, Berglund P, Ragnarsson O. Mental fatigue and executive dysfunction in patients with Cushing’s syndrome in remission. Behav Neurol. 2015;2015:173653. http://doi.org/10.1155/2015/173653en_US
dc.relation.haspartIII. Papakokkinou E, Olsson DS, Chantzichristos D, Dahlqvist P, Segerstedt E, Olsson T, Petersson M, Berinder K, Bensing S, Höybye C, Edén-Engström B, Burman P, Bonelli L, Follin C, Petranek D, Erfurth EM, Wahlberg J, Ekman B, Åkerman AK, Schwarcz E, Bryngelsson IL, Johannsson G, Ragnarsson O. Excess morbidity persists in patients with Cushing’s disease during long-term remission: A Swedish nationwide study. J Clin Endocrinol Metab. 2020;105(8). http://doi.org/10.1210/clinem/dgaa291en_US
dc.relation.haspartIV. Papakokkinou E, Piasecka M, Carlsen HK, Chantzichristos D, Olsson DS, Dahlqvist P, Petersson M, Berinder K, Bensing S, Höybye C, Engström BE, Burman P, Follin C, Petranek D, Erfurth EM, Wahlberg J, Ekman B, Åkerman AK, Schwarcz E, Johannsson G, Falhammar H, Ragnarsson O. Prevalence of Nelson’s syndrome after bilateral adrenalectomy in patients with Cushing’s disease: a systematic review and meta-analysis. Pituitary. 2021;24(5):797-809. http://doi.org/10.1007/s11102-021-01158-zen_US
dc.subjectCushing’s syndromeen_US
dc.subjectCushing’s diseaseen_US
dc.subjectcortisol excessen_US
dc.subjectNelson’s syndromeen_US
dc.subjectmorbidityen_US
dc.subjectremissionen_US
dc.subjectmental fatigueen_US
dc.subjectcognitive functionen_US
dc.subjectadrenal venous samplingen_US
dc.titleClinical challenges in Cushing's syndromeen_US
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.maileleni.papakokkinou@vgregion.seen_US
dc.type.degreeDoctor of Philosophy (Medicine)en_US
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academyen_US
dc.gup.departmentInst of Medicine. Department of Internal Medicine and Clinical Nutritionen_US
dc.gup.defenceplaceOnsdagen den 25 maj 2022, kl. 13.00, Hjärtas Aula, Sahlgrenska Universitetssjukhuset, Vita Stråket 12, Göteborgen_US
dc.gup.defencedate2022-05-25
dc.gup.dissdb-fakultetSA


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