Endocrine Abstracts

Introduction: Cushing’s syndrome is a rare condition, resulting from chronic exposure to excessive circulating levels of glucocorticoids. This condition is highly associated with complications such as cardiovascular and metabolic disorders. This study aims to review the clinical characteristics, diagnosis and treatment of patients with ACTH-dependent Cushing’s syndrome.

Material and Methods: A descriptive and comparative study carried out in the Endocrinology-Diabetology-Nutrition department of Oujda’s Mohammed VI University Hospital, Morocco. The population study included 15 patients with ACTH-dependent Cushing’s syndrome.

Results: The mean age of the patients was 31.7 years (extreme ages 14–151 years) with a female predominance. All patients showed symptoms of hypercortisolism. All patients had elevated midnight blood cortisol, loss of cortisol circadian rhythm and non-suppression of cortisol during 1mg overnight dexamethasone suppression test. All patients responded to 8mg dexamethasone suppression test. The mean ACTH value at the moment of diagnosis was 141.9 ng/l. The hypothalamic-pituitary MRI revealed a pituitary microadenoma in 46.7% of the cases, a macroadenoma in 20% and was negative for 33.3% patients. 7 patients out of 15 received preoperative medical therapies: 42% were treated with Metopirone, and 58% were treated with Ketoconazole. 42.8% of the patients have undergone transsphenoidal surgery for their pituitary adenoma, while 50% had a bilateral adrenalectomy. Fifteen percent of patients needed post-operative conventional radiotherapy and one patient underwent radiosurgery. Meanwhile, one patient refused treatment. The remission rate was around 33.3%. However, 50% experienced an adenoma recurrence.

Conclusion: Cushing’s disease is caused by a pituitary ACTH-secreting adenoma, causing endogenous hypercortisolism. The management of Cushing’s disease and its complications should be discussed over multidisciplinary meetings, including endocrinologists, neurosurgeons and radiologists in order to choose the best treatment plan for the patient.