Endocrine Abstracts

Objective: To assess clinical characteristics, management and outcome of treatment of Cushing’s syndrome (CS) in King Chulalongkorn Memorial Hospital (KCMH).

Method: We performed a retrospective evaluation of 82 patients with CS in KCMH during 2001–2015. Median follow-up time was 36 months [interquartile range 11–35].

Results: Of the 82 patients, Cushing’s disease (CD) was diagnosed in 45 patients (55%). Twenty-six patients had adrenal tumor and 11 patients had ectopic ACTH syndrome. Median age at diagnosis was 38 years old. Median time between first presentation and diagnosis was 12 months. 24% of the patients had normal body mass index. Skin abnormalities (purplish striae, facial plethora, easy bruising) were found in 21–37%. The preoperative ACTH was higher in ectopic ACTH syndrome and CD compared to adrenal Cushing’s syndrome. In CD, 34 patients (76%) had pituitary microadenoma and 11 patients had pituitary macroadenoma (24%). Twenty-five patients (74%) with pituitary microadenoma were cured after their first transphenoidal surgeries. All patients with persistent hypercortisolism were cured after subsequent treatment. In patients with pituitary macroadenoma, five were cured after the first surgeries. Only one patient had remission of CS after subsequent treatment. In adrenal Cushing’s syndrome, cortisol-producing adrenal adenoma was the most common etiology. Median size of tumor was 3 cm. All patients were cured. Ectopic ACTH syndrome were diagnosed in 11 patients. Primary tumors were located in eight patients (bronchial and thymic carcinoids, small cell lung cancer, medullary thyroid carcinoma). Seven patients died and three patients had persistent hypercortisolism. Only one patient was cured.

Conclusions: CD was the most common etiology of CS. However, higher prevalence of adrenal CS was observed. Lower prevalence of patients with overweight or obesity as well as skin abnormalities compared to previous studies. In all subtypes of CS, surgery remained the mainstay of treatment.