Predictive factors for remission and recurrence in Cushing

Joana Oliveira; Eva Lau; Sandra Belo; Paula Freitas; Eduardo Vinha; Josue Pereira; Ligia Castro; Davide Carvalho

doi:10.1530/endoabs.37.EP725

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Endocrine Abstracts (2015) 37 EP725 | DOI: 10.1530/endoabs.37.EP725

ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)

Predictive factors for remission and recurrence in Cushing's disease: a single-centre study

Joana Oliveira ^1, , Eva Lau ^1, , Sandra Belo ^1, , Paula Freitas ^1, , Eduardo Vinha ¹ , Josué Pereira ² , Lígia Castro ³ & Davide Carvalho ^1,

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¹Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal; ²Neurosurgery Department, Centro Hospitalar São João, Porto, Portugal; ³Pathological Anatomy Department, Centro Hospitalar São João, Porto, Portugal; ⁴Faculty of Medicine of University of Porto, Porto, Portugal.

Introduction: Cushing’s disease (CD) is characterised by pathologic hypercortisolism caused by an ACTH-secreting pituitary adenoma. The primary modality for definitive treatment is pituitary surgery. The rarity of CD has made it difficult to establish reliable predictive factors of outcomes.

Aim: Assessment of clinical, hormonal, radiological, surgical and histological findings as predictors of remission and relapse of CD.

Methods: Cross-sectional, retrospective study of patients with CD who underwent pituitary surgery between January/1998 and October/2013.

Results: 45 patients were evaluated, 39 women (86.7%), with a mean age at diagnosis of 38.2±12.9 years, and a mean follow-up of 90.4±56.7 months. After surgery (1st or 2nd intervention), remission of CD was achieved in 26 patients (57.8%) without recurrence until the last evaluation, and it persisted in nine patients (20%). Ten patients (22.2%) relapsed during follow-up. There were no differences between groups (cured, not cured, with disease recurrence) relating age, gender, presence of preoperative comorbidities (hypertension, diabetes, dyslipidemia and psychiatric disorders), hormonal study at diagnosis, magnetic resonance imaging findings or surgical technique. In eight of 45 patients (17.8%) the histological study did not identify the adenoma. Cured patients presented a higher percentage of positive histology for adenoma, followed by patients with disease relapse and uncured patients (92.3% vs 80% vs 55.6%; P=0.045).

Conclusion: The absence of adenoma identification in pituitary histology after surgery was associated with higher risk of persistence or recurrence of CD. Those patients would benefit from a closer follow-up and early evaluation. No other predictive factors were found.