Follow-up intervals in patients with Cushing’s disease: recommendations from a panel of experienced pituitary clinicians

Eliza B. Geer, Alejandro R Ayala, Vivien Bonert, John D. Carmichael, Murray B. Gordon, Laurence Katznelson, Ekaterina Manuylova, Ismat Shafiq, Vijaya Surampudi, Ronald S. Swerdloff, Michael S. Broder, Dasha Cherepanov, Marianne Eagan, Jackie Lee, Qayyim Said, Maureen P. Neary, Beverly M.K. Biller

Research output: Contribution to journalArticle

Abstract

Purpose: Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing’s disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. Methods: The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after (“second round”) an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: “agreement” if no more than two responses were outside a 2 week window around the median response; “disagreement” if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Results: Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8–24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. Conclusions: With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.

Original languageEnglish (US)
Pages (from-to)422-429
Number of pages8
JournalPituitary
Volume20
Issue number4
DOIs
StatePublished - Aug 1 2017

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Pituitary ACTH Hypersecretion
Adrenalectomy
Adrenocorticotropic Hormone
Glucocorticoids
Radiotherapy
Therapeutics
Guidelines

Keywords

  • Biochemical status
  • Consensus statements
  • Cushing’s disease
  • Expert panel
  • Follow-up
  • Treatment

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Geer, E. B., Ayala, A. R., Bonert, V., Carmichael, J. D., Gordon, M. B., Katznelson, L., ... Biller, B. M. K. (2017). Follow-up intervals in patients with Cushing’s disease: recommendations from a panel of experienced pituitary clinicians. Pituitary, 20(4), 422-429. https://doi.org/10.1007/s11102-017-0801-2

Follow-up intervals in patients with Cushing’s disease : recommendations from a panel of experienced pituitary clinicians. / Geer, Eliza B.; Ayala, Alejandro R; Bonert, Vivien; Carmichael, John D.; Gordon, Murray B.; Katznelson, Laurence; Manuylova, Ekaterina; Shafiq, Ismat; Surampudi, Vijaya; Swerdloff, Ronald S.; Broder, Michael S.; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P.; Biller, Beverly M.K.

In: Pituitary, Vol. 20, No. 4, 01.08.2017, p. 422-429.

Research output: Contribution to journalArticle

Geer, EB, Ayala, AR, Bonert, V, Carmichael, JD, Gordon, MB, Katznelson, L, Manuylova, E, Shafiq, I, Surampudi, V, Swerdloff, RS, Broder, MS, Cherepanov, D, Eagan, M, Lee, J, Said, Q, Neary, MP & Biller, BMK 2017, 'Follow-up intervals in patients with Cushing’s disease: recommendations from a panel of experienced pituitary clinicians', Pituitary, vol. 20, no. 4, pp. 422-429. https://doi.org/10.1007/s11102-017-0801-2
Geer, Eliza B. ; Ayala, Alejandro R ; Bonert, Vivien ; Carmichael, John D. ; Gordon, Murray B. ; Katznelson, Laurence ; Manuylova, Ekaterina ; Shafiq, Ismat ; Surampudi, Vijaya ; Swerdloff, Ronald S. ; Broder, Michael S. ; Cherepanov, Dasha ; Eagan, Marianne ; Lee, Jackie ; Said, Qayyim ; Neary, Maureen P. ; Biller, Beverly M.K. / Follow-up intervals in patients with Cushing’s disease : recommendations from a panel of experienced pituitary clinicians. In: Pituitary. 2017 ; Vol. 20, No. 4. pp. 422-429.
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abstract = "Purpose: Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing’s disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. Methods: The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after (“second round”) an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: “agreement” if no more than two responses were outside a 2 week window around the median response; “disagreement” if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Results: Panel agreement was 65.9{\%} before and 88.6{\%} after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8–24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. Conclusions: With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.",
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AU - Carmichael, John D.

AU - Gordon, Murray B.

AU - Katznelson, Laurence

AU - Manuylova, Ekaterina

AU - Shafiq, Ismat

AU - Surampudi, Vijaya

AU - Swerdloff, Ronald S.

AU - Broder, Michael S.

AU - Cherepanov, Dasha

AU - Eagan, Marianne

AU - Lee, Jackie

AU - Said, Qayyim

AU - Neary, Maureen P.

AU - Biller, Beverly M.K.

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