A survey of clinical practice patterns in diagnosis and management of Cushing's disease in Iran

Background: Cushing's disease is the most prevalent cause of endogenous adrenocorticotrophic hormone hypersecretion. The aim of this study was to document the current clinical practice pattern in the management of Cushing's disease by Iranian Endocrinologists to determine their opinions and compare them with the current clinical practice guidelines. Methods: An eight-item questionnaire dealing with diagnosis, treatment and follow up of patients with Cushing's disease was developed, piloted, and sent to the members of Iranian Endocrinology Society. Results: Among 90 endocrinologists invited to participate in the survey, 76 replied. Most respondents selected overnight dexamethasone suppression test (ONDST) and assessment of 24-hour urinary free cortisol (UFC) as the best screening tests followed by midnight serum cortisol and midnight salivary cortisol. Classic high dose dexamethasone suppression test and measurement of serum ACTH were selected for localization of the primary lesion by 64.5. The primary choice of treatment was trans-sphenoidal pituitary surgery (86.8). For the recurrence of Cushing's disease, the preferred treatment modality was medical therapy followed by bilateral adrenalectomy, and pituitary re-surgery. In case of treatment failure after the first pituitary surgery and ketoconazole treatment, 51 chose bilateral adrenalectomy, while36.8 selected pasireotide only. Conclusion: ONDST and UFC are two most common tests used to screen an index case with signs and symptoms of hypercortisolism. The primary choice of treatment in Cushing's disease is pituitary surgery. However, medical treatment by ketokonazol is preferred for the recurrences. Pasireotide is the second alternative after bilateral adrenalectomy in case of treatment failure after pituitary surgery and ketoconazole

A survey of clinical practice patterns in diagnosis and management of Cushing's disease in Iran

Background: Cushing's disease is the most prevalent cause of endogenous adrenocorticotrophic hormone hypersecretion. The aim of this study was to document the current clinical practice pattern in the management of Cushing's disease by Iranian Endocrinologists to determine their opinions and compare them with the current clinical practice guidelines. Methods: An eight-item questionnaire dealing with diagnosis, treatment and follow up of patients with Cushing's disease was developed, piloted, and sent to the members of Iranian Endocrinology Society. Results: Among 90 endocrinologists invited to participate in the survey, 76 replied. Most respondents selected overnight dexamethasone suppression test (ONDST) and assessment of 24-hour urinary free cortisol (UFC) as the best screening tests followed by midnight serum cortisol and midnight salivary cortisol. Classic high dose dexamethasone suppression test and measurement of serum ACTH were selected for localization of the primary lesion by 64.5. The primary choice of treatment was trans-sphenoidal pituitary surgery (86.8). For the recurrence of Cushing's disease, the preferred treatment modality was medical therapy followed by bilateral adrenalectomy, and pituitary re-surgery. In case of treatment failure after the first pituitary surgery and ketoconazole treatment, 51 chose bilateral adrenalectomy, while36.8 selected pasireotide only. Conclusion: ONDST and UFC are two most common tests used to screen an index case with signs and symptoms of hypercortisolism. The primary choice of treatment in Cushing's disease is pituitary surgery. However, medical treatment by ketokonazol is preferred for the recurrences. Pasireotide is the second alternative after bilateral adrenalectomy in case of treatment failure after pituitary surgery and ketoconazole

Using graphene networks to build bioinspired self-monitoring ceramics

We acknowledge the EPSRC Grant Graphene 3D Networks (EP/K01658X/1), EPSRC founded Center for Advanced Structural Ceramics (CASC) at Imperial College London. O.T.P. thanks Nanoforce Technology Ltd. for their facilities and V.G.R. thank the European Commission (FP7—Marie Curie Intra-European Fellowship GRAPES). C.F. thanks the European Commission funding under the 7th Framework Programme (Marie Curie Initial Training Networks; grant number: 289958, Bioceramics for Bone Repair). N.N. acknowledges the funding from Imperial College Junior Research Fellowship. X-ray photoelectron spectra were obtained at the National EPSRC XPS Users’ Service (NEXUS) at Newcastle University, an EPSRC Mid-Range Facility. We acknowledge Dr. I.J.Villar-Garcia support on XPS data processing and analysis