Pneumocystis pneumonia in patients with Cushing's syndrome: A French multicenter retrospective study

被引：15

作者：

Lugat, Alexandre ^{[1
,2
]}

Lasolle, Helene ^{[3
,4
,5
]}

Francois, Maud ^{[6
]}

Benhenda, Nesrine

Bricaire, Leopoldine ^{[7
,8
]}

Cornu, Erika ^{[9
]}

Cristante, Justine ^{[10
]}

Gitton, Anne ^{[6
]}

Hadoux, Julien ^{[11
,12
]}

Kerlan, Veronique ^{[13
]}

Le Bras, Maelle ^{[14
]}

Mezzaroba, Vincent ^{[3
,5
]}

Puerto, Marie ^{[15
]}

Storey, Caroline ^{[16
]}

Ouzounian, Sophie ^{[17
]}

Donadille, Bruno ^{[17
]}

Raverot, Gerald ^{[3
,4
,5
]}

Drui, Delphine ^{[14
]}

Haissaguerre, Magalie ^{[15
]}

机构：

[1] CHU Nantes, Med Oncol Dept, F-44000 Nantes, France

[2] Univ Angers, Nantes Univ, CNRS 6075, Inserm 1307,CRCI2NA, Nantes, France

[3] Hosp Civils Lyon, Reference Ctr Rare Pituitary Dis HYPO, Endocrinol Dept, Grp Hosp Est, Bron, France

[4] Lyon 1 Univ, Villeurbanne, France

[5] Canc Res Ctr Lyon CRLC, INSERM U1052, CNRC UMR5286, Lyon, France

[6] Ctr Hosp Univ Reims, Endocrinol Diabetol & Nutr, Reims, France

[7] Hop Cochin, Assistance Publ Hop Paris, Dept Endocrinol, F-75014 Paris, France

[8] Hop Cochin, Assistance Publ Hop Paris, Natl Reference Ctr Rare Adrenal Disorders, F-75014 Paris, France

[9] Hop Europeen Georges Pompidou, Hypertens Unit, Paris, France

[10] CHU Grenoble Alpes, Endocrinol Unit, F-38043 Grenoble, France

[11] Gustave Roussy, Dept Endocrine Oncol & Nucl Med, Villejuif, France

[12] Univ Paris Saclay, Villejuif, France

[13] Hop Cavale Blanche, Dept Endocrinol Diabet & Metab Dis, Brest, France

[14] CHU Nantes, Inst Thorax, Dept Endocrinol Diabetol & Nutr, Nantes, France

[15] Haut Leveque Univ Hosp, Dept Endocrinol, Bordeaux, France

[16] Robert Debre Teaching Hosp, Assistance Publ Hop Paris, Dept Paediat Endocrinol & Diabetol, Paris, France

[17] Sorbonne Univ, St Antoine Hosp, Assistance Publ Hop Paris, Endocrinol Dept, Paris, France

来源：

ANNALES D ENDOCRINOLOGIE | 2023年 / 84卷 / 01期

关键词：

Cushing?s syndrome; Ectopic ACTH secretion; Pituitary adenoma; Pneumocystis pneumonia; Pneumocystis jirovecii; CARINII-PNEUMONIA; JIROVECII PNEUMONIA; NEUROENDOCRINE CARCINOMA; HYPERCORTISOLISM; RISK; PROPHYLAXIS; AUTOIMMUNE; PREVENTION; MANAGEMENT; INFECTION;

D O I：

10.1016/j.ando.2022.09.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective. - Pneumocystis pneumonia (PcP) is an opportunistic infection occurring in immunocompro-mised patients. Cushing's syndrome (CS) impairs the immune system, and several authors have reported PcP in patients with CS. The present study aimed to characterize PcP occurring in a CS context and its management in French tertiary centers, in order to highlight the similarities in clinical presentation and treatment according to whether prophylaxis is implemented or not.Methods. - This was a multicenter retrospective study conducted in several French University Hospitals and Cancer Centers. Patients with PcP and confirmed CS regardless of etiology were included. We excluded patients with other known causes of acquired immunodeficiency with increased risk of PcP.Results. - Twenty-five patients were included. CS etiology was neoplastic in 84.0% of cases. CS clinical pre-sentation associated predominant catabolic signs (76.0%), hypokalemia (91.7%) and lymphopenia (89.5%). CS was intense in most patients, with mean plasma cortisol levels at diagnosis of 2.424 +/- 1.102 nmol/L and urinary free cortisol > 10x the upper limit of normal in 85.0%. In all patients, PcP onset followed introduction of cortisol blockers, at a median 5.5 days. Patients were treated with 1 to 3 cortisol blockers, mainly metyrapone (88%), which significatively lowered plasma cortisol levels to 667 +/- 541 nmol/L at the onset of PcP (P < 0.001). PcP occurred in 7 patients despite prophylaxis. Finally, 60.0% patients were admitted to intensive care, and 20.0% died of PcP.Conclusion. - High mortality in patients with PcP implies that clinicians should be better informed about this rare infectious complication. Prophylaxis remains controversial, requiring comparative studies.(c) 2022 Published by Elsevier Masson SAS.

引用

页码：37 / 44

页数：8

共 51 条

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