Endocrine Abstracts

Cushing’s disease (CD) remission after primary surgical treatment is achieved in 70–90%, but recurrence ranges 18–25% after.

The aim of this work was to study clinical, hormonal and MRI indicators before and after surgical treatment in patients with recurrent CD to identify possible predictors of recurrence. We examined 49 patients with recurrent CD in the active stage (disease duration up to 3 years). Before neurosurgery blood ACTH (median 80.0 PG/ml) and cortisol (median 689.5 nmol/l), free cortisol level in daily urine (median 1336.5 nmol/24 h) and 23:00 free cortisol in saliva (median of 18.4 nmol/l) were increased. 99.4% of patients had decreased cortisol with 74.7% from baseline during HDDST, 10.6% were negative. Microadenoma in 69.9%, macroadenoma in 30.1%. ACTH levels were correlated with the tumour volume.

According to the results surgical treatment patients were divided into 2 groups. The 1st group 19 patients (38.8%) in whom the remission developed and adrenal insufficiency (AI) signs appeared in 78.9% (15 patients), in 4 patients AI was absent. Remission lasted from 3 to 3.9 years, In 30 patients from 2nd group (61.2%) the remission was not achieved. In the group with remission there was a significant decrease blood ACTH and cortisol concentration in the early postoperative period (7–10 days) and the normalization of rhythm. The ACTH level was markedly decreased in the subgroup with AI. Remission was longer in all patients with AI. Cortisol levels reduction in patients with AI was 75% and in patients without AI - 65% in HDDST before the surgery.

Thus, the adenoma size (microadenoma), a more pronounced cortisol reduction during HDDST before the operation, the presence of AI and the average ACTH level below 10.0 PG/ml after surgery can be used as predictors of longer CD remission.