Endocrine Abstracts

Cushing’s syndrome is a rare endocrine disorder which the Royal College of Physicians/Society for Endocrinology Guidelines – Pituitary Tumours (1997) suggest should only be differentially diagnosed in centres with appropriate technical and enocrinological expertise. We conducted an audit against these guidelines of the management of Cushing’s syndrome in our unit (population covered 250, 000) over the 3-year period between January 2003 and January 2006. Aetiologies of the 8 cases diagnosed were pituitary adenoma (4) 1 male, 3 female mean age 39.25 years, adrenal adenoma (3) 3 female mean age 45 years and ectopic ACTH from an adrenal phaeochromocytoma (1) female aged 67 years. Timing of the sequence of events in weeks (mean and range) from referral were as follows:

Pituitary

Diagnosis 4 weeks (1 to 9), MRI scan 7.5 weeks (3 to 15), inferior petrosal sinus sampling 18 weeks (12 to 36) and surgery 40 weeks (24 to 52).

Adrenal

Diagnosis 2.3 weeks (2 to 3), CT scan 7.3 weeks (2 to 12), surgery 16 weeks (8 to 14).

Ectopic

Diagnosis 2 weeks (CT performed prior to referral), surgery 6 weeks.

Outcomes

Pituitary – 3 in remission, adrenal – all cured, ectopic – cured.

Laparoscopic adrenalectomy was performed at one, inferior petrosal sinus sampling at two and pituitary surgery at three tertiary centres. Postoperative assessment and follow-up was performed locally, other than for the single non cured pituitary patient.

These results show that the differential diagnosis of Cushing’s syndrome can be efficiently and correctly performed in a fairly geographically remote district general hospital. This, along with local post-operative assessment and follow-up is most convenient for the patients. Networking with tertiary centres for specialised investigations and surgery whilst demonstrated to be effective are the rate limiting steps in the management process.