Endocrine Abstracts

In our study we included retrospective analyses of 101 patients (mean age 35 years, 85 women and 16 men) with Cushing’s disease (CD), who underwent transsphenoidal surgery (TSS) treatment. CD is based on clinical suspicion, hormonal research of cortisol (F), ACTH, 24-hous urine F, results of dexamethasone suppression tests low (1 mg) dose (LDDST) and high (8 mg) dose (HDDST) and MR-imaging (MRI). Before the operation all patients have high F, ACTH, negative LDDST and positive HDDST, abnormal responses to tests desmopressin (DDAVP), insulin and pituitary adenomas on MRI (76% -microadenoma and 24% - macroadenjma). Post-operative pituitary and adrenal functions were assessed after 5–10 days (serum F - post F), then every year. 74% of patients had adrenal deficiency after TSS. The results of serum post F, circadian rhythm F, ACTH, LDDST, desmopressin, and insulin tests were the criteria to define cure or remission. 82% of patients had clinical and biochemical remission over 6 month, 84% over 12 month after TSS.

75% of the patients have prolonged remission during long-term follow-up (in average 8,6 years).

Recurrent (R) in 12.4% of patients initially deemed to be remission, at a mean of 69 months. After 12 months the patients with R had post F >50 nmol/l, evaluation ACTH and F after DDAVP, but normal test LDDST.

Conclusion: Results of the study confirm the facts that the predictive value for long-term remission CD are: postoperative 09.00 h serum cortisol values < 50 nmol/l; normal 24-hous urine F; normal circadian rhythm F, ACTH; normal LDDST, negative test with (DDAVP), normal response F and ACTH to insulin test over 12 month after TSS.