ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Sex-related differences in clinical presentation and outcomes of Cushing's disease: a study from a referral centre
Eva Lau 1, , Joana Oliveira 1, , Sandra Belo 1, , Paula Freitas 1, , Ana Isabel Oliveira 1, , Eduardo Vinha 1 , Lígia Castro 2 , Josué Pereira 3 & Davide Carvalho 1,
1Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, EPE, Porto, Portugal; 2Pathological Anatomy Department, Centro Hospitalar São João, EPE, Porto, Portugal; 3Neurosurgery Department, Centro Hospitalar São João, EPE, Porto, Portugal; 4Faculty of Medicine, University of Porto, Porto, Portugal.
Introduction: Cushing’s disease (CD) presents a marked female preponderance, with a female-to-male ratio of 3–8:1, but whether this skewed gender distribution has any relevance to the presentation and outcomes of CD is not well understood.
Aim: To evaluate sex-related differences in the presentation of CD, as regards: biochemical indices of hypercortisolism; complications of disease and outcomes.
Methods: Observational, retrospective study of patients with CD confirmed on pituitary surgery between January 1998 and October 2013.
Results: We included 45 patients, of whom 39 (87%) were women. The mean age at diagnosis was 38.2 (12.9) years and the mean follow-up period was 90.4 (56.7) months. Diabetes was more prevalent in males (50% vs 26.3%), as well as hypertension (83% vs 61%) and dyslipidaemia (66.7% vs 40.5%). The psychiatric disorders were more frequent in females (56.8% vs 16.7%). Most women (56.8%) presented a microadenoma on MRI; 33% of men had a microadenoma and 50% a macroadenoma. CD remission was found in 74.4% of women who underwent pituitary surgery; in men remission occurred in 66.7%. At diagnosis, there were no significant differences in serum cortisol levels, urinary free cortisol, midnight cortisol or cortisol levels after overnight dexamethasone suppression test. Male patients had higher basal levels of ACTH (106.5 (46.0) pg/ml vs 70.5 (38.7) pg/ml, P=0.048) and serum cortisol after 2-day dexamethasone suppression test (40.5 (51.7) μg/dl vs 13.3 (11.0) μg/dl, P=0.015). No differences were found in serum cortisol or urinary free cortisol suppression after high-dose suppression test, by sex.
Conclusion: Biochemical indices of hypercortisolism, metabolic and psychiatric disorders, as long as outcomes of CD differed by sex. Understanding this dimorphic pattern may be relevant in order to define the adequate diagnostic work-up and follow-up of these patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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