BACKGROUND: While surgery is the first-line treatment for patients with endogenous hypercortisolism (Cushing syndrome [CS]), mifepristone has been shown to be a beneficial medical treatment option, as demonstrated in the SEISMIC (Study of the Efficacy and Safety of Mifepristone in the Treatment of Endogenous Cushing Syndrome) trial. Mifepristone is a competitive glucocorticoid receptor antagonist and progesterone receptor antagonist that is associated with several treatment effects and adverse events that clinicians need to be aware of when considering its use. The objective of this review was to provide updated clinical management recommendations for patients with CS treated with mifepristone.
METHODS: A panel of endocrinologists from the US with extensive experience in treating patients with CS, including with mifepristone, convened as part of a clinical advisory board to develop a consensus on the practical, real-world clinical management of patients on mifepristone.
RESULTS: Comprehensive considerations and recommendations are provided for managing mifepristone-associated effects, including symptoms of cortisol withdrawal, hypokalemia, and change in thyroid function; effects related to its antiprogesterone activity; and rash. Additional management strategies to address concomitant medications and special clinical situations, such as surgery and use in specific populations, are also provided.
CONCLUSIONS: Safe and effective use of mifepristone requires clinical judgment and close patient monitoring to ensure optimal clinical outcomes. These consensus recommendations provide useful, practical guidance to clinicians using mifepristone.

The recent advances in the field of flow cytometry have resulted in instrumentation with increased capacity which is actually more user-friendly. Thus, the technology has become more valuable to research scientists, the pharmaceutical industry and clinical laboratories. The use of flow cytometry in regulated labs has been hampered by the challenges associated method validation and the lack of official guidance documents on the topic. Thus key stakeholders have published recommendation papers with the hope that these will be incorporated as official guidance documents. This review will focus on the achievements of the stakeholders and a high-level overview their recommendations.

Patients requiring urgent cardiac surgery are usually already taking antiplatelet drugs including aspirin and a P2Y12 ADP receptor antagonist (e.g., clopidogrel, prasugrel or ticagrelor). This presents clinicians with the challenge of balancing the risk of thrombotic complications, if antiplatelet drugs are stopped before surgery, with the problems of excessive bleeding when surgery is performed in the absence of adequate platelet function. Preoperative platelet function monitoring is able to identify when patients have recovered platelet function. The Multiplate(®) (multiple electrode impedance platelet aggregometer) is a point of care device that enables monitoring of platelet function. The authors offer recommendations based on real-world, collective experience in the use of platelet function monitoring. These cover the use of the Multiplate(®) analyser to predict the need for platelet transfusion in the perioperative period and the individualized waiting period after cessation of P2Y12 ADP receptor antagonists before cardiac surgery.