Endocrine Abstracts

Objective: Cushing’s disease (CD) is caused by pituitary corticotrophin (ACTH)-secreting tumours. Our aim is to show our experience in a third level hospital attending a 500 000 based population area from 1990 to now.

Methods: We review retrospectively the medical reports of all patients diagnosed as CD from 1990 by a data collection protocol. We reject the reports without enough or inadequate information. We present results by using descriptive statistics.

Results: 29 patients were diagnosed as CD in the period study (estimate average incidence of 2.41 cases/million people per year). Nine medical reports contain insufficient or misleading information including two from dead patients. The remaining 20 patients were included in our analysis. Mean age at diagnosis was 39 years (range 17–75 years) with a bimodal distribution. Mean BMI was 28.45 kg/m². Mean follow up time was 11 years (range 2–24). 90% were women. Reference most common reason was hyperandrogenism (acne and hirsutism, 55%). Most common symptom were also hirsutism, 65%. Mean plasma basal cortisol value was 27.9 μg/dl (range 18–51 μg/dl). Mean basal cortisol value after 1 mg of DXM was 14.6 μg/dl (3.38–34.9 μg/dl). Mean basal cortisol value after 4 mg of DXM was 14.53 μg/dl (3.08–23.46 μg/dl). Mean basal cortisol value after 8 mg of DXM was 7.96 μg/dl (0.34–24.45 μg/dl). Mean 24-h urinary free cortisol value was 840.7 μg/24-h (97–5530 μg/24-h). Mean cortisol value at midnight was 13.63 μg/dl (9.26–18.03 μg/dl). Mean ACTH value was 71.96 pg/dl (20–231 pg/dl). 35% of tumours were not visible at MRI, 55% were microadenomas and 10% macroadenomas. 95% of patients were treated surgically. The ratio of curation after the first surgery was 65%. One patient (5%) was treated only pharmacologically (ketoconazole) and remain controlled after 9 years of follow up. 30% of patients required a second treatment. Mean time to this second treatment was 5.32 years (range 0.3–12 years). 30% of patients required a second surgery with a curation rate of 50%. 15% of patients have required radiotherapy and 5% bilateral adrenalectomy. 15% of patients remain with hypopituitarism and 35% with hydrocortisone supplementation.

Conclusions: Our patients reproduce well referenced data from other series. Hiperandrogenism was the main cause of consultation.