Cushing

Ana Coelho Gomes; Lia Lucas Neto; Francisco Tortosa; Maria Raquel Carvalho; Eduardo Barreiros; Luis Barreiros; Jose Miguens; Maria Joao Bugalho

doi:10.1530/endoabs.49.EP974

EP974

Prev Next

Section Contents Cite

Endocrine Abstracts (2017) 49 EP974 | DOI: 10.1530/endoabs.49.EP974

ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (145 abstracts)

Cushing’s disease: is there a Continuum from corticotroph hyperplasia to adenoma?

Ana Coelho Gomes ¹ , Lia Lucas Neto ² , Francisco Tortosa ³ , Maria Raquel Carvalho ¹ , Eduardo Barreiros ¹ , Luís Barreiros ¹ , José Miguéns ⁴ & Maria João Bugalho ¹

Err

Author affiliations

¹Endocrinology, Diabetes and Metabolism Department, Santa Maria Hospital, Lisbon, Portugal; ²Neuroradiology Department, Santa Maria Hospital, Lisbon, Portugal; ³Pathology Department, Santa Maria Hospital, Lisbon, Portugal; ⁴Neurosurgery Department, Santa Maria Hospital, Lisbon, Portugal.

Introduction: Successful long-term management of patients with Cushing’s disease (CD) remains a challenge. Few studies have analyzed the long-term recurrence rates of CD after transsphenoidal surgery (TS).

Objectives: 1) to compare the outcome of patients with and without postoperative criteria for cure; 2) to compare the outcome of patients with and without a histological diagnosis of adenoma.

Methods: Retrospective, descriptive study. Forty-two patients with CD submitted to TS between 2005 and 2016 were included. Variables analyzed: postoperative criteria for cure, CD remission and recurrence rates, histological findings.

Results: Surgical remission was achieved in thirty-eight patients. The mean follow-up was 6.8 years. Sixteen patients recurred. The mean time to recurrence was 4.6 years. Immediate postoperative evaluation was performed in 34 cases; criteria for cure were observed in seventeen. Patients with clinical recurrence who presented postoperative criteria for cure had a mean disease free-time of 7.1 years, opposed to 2.2 years in those without biochemical criteria for cure (P-value 0.032). Six patients without biochemical criteria for cure after surgery are in remission. Histology documented an adenoma in thirty patients; from these, eleven recurred.

Discussion: In this study, 42.1% of the patients who achieved remission, after TS, recurred. This finding emphasizes the need for continued biochemical and clinical follow-up. On the other hand, some patients without postoperative criteria for cure were in remission, at last observation. Thus, suggesting that biochemical criteria for cure may be achieved at different timings from patient to patient. Evidence for recurrence in eleven patients with adenoma suggests that CD may be a continuum, in which there is a basal corticotroph hyperplasia likely to evolve to adenoma.