Endocrine Abstracts

The definitive treatment for Cushing’s disease is curative surgery. Patients with severe disease burden will likely require pre-operative medical blockade to reduce the risk of peri- and post-operative complications. The threshold for deciding when to medically block excess cortisol is currently based on clinical judgment. Expert centres may use a different criteria to determine this. There is no widely adopted tool for evaluating the clinical severity of Cushing’s disease.

Methods: We retrospectively identified 30 consecutive patients diagnosed with Cushing’s disease who proceeded to transphenoidal surgery. Using the Sonino Cushing’s severity index (CSI) we then retrospectively calculated each patient’s clinical severity disease score by reviewing their medical notes.

Results: All 30 patients (100%) had sufficient information documented in their medical records to enable retrospective calculation of their CSI score (mean 5.8, range 0–10). Twenty-three percent (7/30) received pre-operative medical blockade. Of the seven patients who received blockade: five received metyrapone alone, one ketoconazole alone, and one received both metyrapone and ketoconazole. The mean duration of blockade was 14 weeks (range 2–30). The mean CSI of patients deemed to need pre-operative blockade was 7.9 compared to 5.2 in the patients who were deemed to not need prior optimisation (P=0.017). Only one of 18 patients (6%) with a CSI <7 was prescribed blockade. Six of the 12 patients (50%) with a SCI in the range ≥7 received medical blockade.

Conclusion: We report our recent practice which shows that patients with a CSI of <7 are very unlikely to require pre-operative medical blockade. However, CSI of 7–9 will often be an indication for blockade and CSI of ≥10 is highly likely to be an indication. As such this scoring system with these associated cut off values could easily be utilised in clinical practice to guide medical decision making and facilitate comparison outcomes between expert centres.