Endocrine Abstracts

Objective: Transsphenoidal surgery (TSS) presents the treatment of choice for Cushing’s disease (CD), 95% microadenomas. Remission and recurrence rates vary dependent on tumor size, extension, adenoma visibility on magnetic resonance imaging, and neurosurgical expertise. Remission rates in the postoperative vary between 55 and 85%, with a recurrence of up to 25%. The aim of this study was to describe the rate of remission and recurrence of CD in our midst after TSS, and compare it with that described in the literature.

Patients and methods: We conducted a retrospective analysis of patients who underwent as TSS for CD between 1994 and 2013. Variables analyzed: age, sex, time to diagnosis, tumor size, serum cortisol, urinary-free cortisol (UFC), remission, persistence and recurrence of CD. Remission was defined as normalization of serum cortisol and UFC levels, persistence as no normalization of serum cortisol and UFC levels after TSS and recurrence as presence of elevated serum cortisol and UFC levels after having achieved remission.

Results: Thirty-eight patients with CD treated with TSS. 42.76±14 years old. Women: 83.7%. Time to diagnosis: 30.39±29.67 months. Macroadenomas 28.9% (P=0.01), tumor size 8.68±75 mm. Remission 52.6% (P=0.21), persistence 13.2% and recurrence 34.2% (P=0.77). Adrenal insufficiency: 13.2%. Time from surgery to recurrence: 49.23±50.8 months. Treatment of recurrent: 42.9% TSS, 50% radiotherapy and 2.6% medical treatment. Second recurrence: 8%. Remission of CD at the end of the follow-up: 72.2% (P=0.26). Death: 2.8%.

Conclusions: CD is more common in women in the fourth decade of life. Remission and recurrence of CD is similar to that described in the literature. Percentage of macroadenoma is higher than reported in other series.