Management of Cushing

Mirsala Solak; Ivana Kraljevic; Tina Dusek; Ante Melada; Marcel Marjanovic Kavanagh; Vjerislav Peterkovic; David Ozretic; Darko Kastelan

doi:10.1530/endoabs.37.EP817

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Endocrine Abstracts (2015) 37 EP817 | DOI: 10.1530/endoabs.37.EP817

ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)

Management of Cushing's disease: single centre experience

Mirsala Solak ¹ , Ivana Kraljevic ¹ , Tina Dusek ¹ , Ante Melada ² , Marcel Marjanovic Kavanagh ³ , Vjerislav Peterkovic ² , David Ozretic ⁴ & Darko Kastelan ¹

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¹Department of Endocrinology, Center of Neuroendocrinology Zagreb, Zagreb, Croatia; ²Department of Neurosurgery, Center of Neuroendocrinology Zagreb, Zagreb, Croatia; ³Department of Otorinolaringology, Zagreb, Croatia; ⁴Department of Radiology, University Hospital Center, Zagreb, Croatia, Zagerb, Croatia.

Introduction: Cushing’s disease (CD) is an uncommon condition of excess endogenous glucocorticoids caused by ACTH secreting pituitary corticotroph adenoma. The purpose of this study is to review therapeutic outcomes and comorbidity of patients with CD in a single centre.

Methods: We conducted a retrospective study of 33 patients with CD undergoing transsphenoidal surgery from January 2007 to February 2014. (27 female and six male, median age 38 years, range 18–71 years). The diagnosis of Cushing’s syndrome was established on the basis of the patient’s history, characteristic clinical features and laboratory data, including elevated 24-h urinary free cortisol (UFC) level, lack of serum cortisol suppression after suppression tests (1-mg overnight dexamethasone suppression test and/or 2 mg-2 days dexamethasone suppression test) and elevated midnight cortisol level. In 28/33 patients tumor was visualised on MR of sellar region, while in five it was diagnosed using an inferior petrosal sinus sampling.

Results: Ten patients had macroadenoma, the remaining 23 had microadenoma. Twenty-one patients (63.6%) had hypertension, 17 (51.5%) dyslipidemia, while 7 (21.2%) had type 2 diabetes or Impaired Glucose Tolerance. Median follow-up period was 58.3 months. Remission after transsphenoidal surgery was achieved in 78.8% of patients, while seven patients failed to achieve disease remission. They were treated with second-line treatment modalities (second operation, radiotherapy, bilateral adrenalectomy and/or ketoconazole). One patient rejected all treatment modalities after surgery.

Conclusion: Cumulative remission after all treatment modalities was achieved in 93.9% patients. Two female patients had recurrence of hypercortisolism. The results of our Centre are comparable to leading centers in the world.