ECE2014 Poster Presentations Neuroendocrinology (27 abstracts)
Long-term remission and recurrence rate in a cohort of Cushing's disease: The need for long-term follow-up
Gloria B. Aranda Velazquez 1, , Felicia A. Hanzu 1, , Mireia Mora Porta 1, , Joaquin Enseñat 3 , Manel Puig-Domingo 1 , María Jesus Martínez de Osaba 5 , Gregori Casals 5 , Eugenia Verger 6 , María Teresa Ribalta 7 , Ioana Patrascioiu 1 & Irene Halperin 1,
1Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain, 2CIBER de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain, 3Department of Neurosurgery, Barcelona, Spain, 4Laboratory of Endocrine Disorders, IDIBAPS, Barcelona, Spain, 5Hormonal Laboratory, Hospital Clinic, Barcelona, Spain, 6Department of Oncology Radiotherapy, Hospital Clinic, Barcelona, Spain, 7Department of Anatomo-Patology, Barcelona, Spain.
Introduction: Transsphenoidal surgery (TSS) is the procedure of choice in Cushing disease (CD), with immediate post-operative remission rates ranging between 59 and 94% and recurrence rates between 3 and 46%, both depending upon the definition criteria and the duration of the follow-up. Our aim was to assess the rate of remission, recurrence and persistence of the disease after the first treatment and to identify predictors of remission in the CD population of our center during the last 40 years.
Methods: Retrospective cohort study of the patients diagnosed of CD and with complete follow-up in our center between 1974 and 2011. We analyzed 41 patients (35 women and 6 men) with a mean age at diagnosis of 34±13 years and mean follow-up of 14±10 years (1–37years).
Results: Thirty-five (85.4%) patients underwent transsphenoidal surgery as first treatment option. Histopathological evidence of a pituitary adenoma was registered in seventeen (48.5%) patients. Thirty-two (78%) patients achieved disease remission after the first treatment, 21 (65.6%) of them presented disease recurrence. Persistent disease was observed in 9 (22%) patients. Twelve (29.3%) subjects developed post-surgical adrenal insufficiency; seven of them (70%) achieved stable remission. Two parameters were found to be significant predictors of remission after the first treatment: age at CD diagnosis and the development of adrenal insufficiency (cortisol<3 ug/dl) in the immediate post-operative state. The overall rate of hypopituitarism observed in our serie was 53.7%, significantly higher when compared to other studies.
Conclusions: The recurrence rate in our serie is higher than in many others probably due to the long follow-up time. Early post-surgery adrenal insufficiency predicts remission rate. Hypopituitarism was also higher and strongly associated with radiotherapy. This leads us to the conclusion that CD needs a life-long strict follow-up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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