ICEECE2012 Poster Presentations Adrenal cortex (113 abstracts)
Cushing’s disease – limitations and boundaries
J. Idriceanu 1 , C. Preda 1 , C. Galesanu 1 , M. Ungureanu 1 , V. Scripcariu 2 , I. Vasiliu 1 , I. Potorac 1 , R. Popovici 1 , V. Mogos 1 & C. Vulpoi 1
1University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania, 2University of Medicine and Pharmacy ‘Gr.T.Popa’ I, Iasi, Romania.
Introduction: Cushing’s disease is the most frequent cause of hypercortisolism. Although the classical form is easy to diagnose, nonspecific features raise differential diagnosis problems. Severe forms are associated with high mortality, but subclinical hypercortisolism also has significant morbidity.
Patients and methods: Retrospective study of Cushing’s disease evolution in 14 patients, diagnosed between 2000 and 2011 (11 women, 3 men, age at diagnostic 22–48 years).
Results: Clinical: 42.86% patients were overweight and 42.86% obese; 78.58% hypertensive; 92.85% had purple striae, 71.42% muscle weakness and 70% of women secondary amenorrhea. All patients had hypercortisolism (384.81 ng/ml±140.04), disturbed nictemeral rhythm and high ACTH (311.61 pg/ml±422.45). Diagnosis was supported by inhibition and/or stimulation tests. Over 1/3 had metabolic syndrome and three cases had electrolyte impairment. Pituitary adenoma was identified in nine cases (64.28%, two macroadenomas and seven microadenomas). Only four patients had pituitary adenomectomy (one with complete remission), eight bilateral adrenalectomy, followed in four cases by pituitary radiotherapy, one patient, newly diagnosed, had not yet been treated and one was lost of the view. Steroidogenesis inhibitors were administrated in five patients (preoperative or recurrence) and dopamine receptor analogues in three cases. Therefore, half of patients are in remission, 28.58% relapsed and 21.42% in evolution (recent diagnosed).
Discussions: Although the first line therapy in Cushing’s disease is pituitary surgery, it is often difficult to perform it. Given the unpredictable evolution of the disease, combined treatment is often necessary, with better outcomes, but many patients relapse after successful initial treatment (10–20% in specialized centers, >1/4 in our series).
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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