ECE2020 ePoster Presentations Pituitary and Neuroendocrinology (94 abstracts)
Can you predict the success of surgery in cushing’s disease?
Paloma Moreno-Moreno 1 , Alfonso Soto-Moreno 2 , Carmen Fajardo-Montañana 3 , Rosa Camara-Gómez 4 , Raul M Luque 5 & María Ángeles Gálvez-Moreno 1
1University Hospital Reina Sofía, Management Unit of Clinical Endocrinology and Nutrition, Córdoba, Spain; 2University Hospital Virgen del Rocío, Management Unit of Clinical Endocrinology and Nutrition, Sevilla, Spain; 3University Hospital La Ribera, Management Unit of Clinical Endocrinology and Nutrition, Alcira, Spain; 4University and Polytechnic Hospital La Fe, Management Unit of Clinical Endocrinology and Nutrition, Valencia, Spain; 5University of Córdoba. IMIBIC, Department of Cell Biology, Physiology and Immunology, Córdoba, Spain
Objective: Cushing’s disease (CD) is difficult to diagnose because of its rarity and because its most common symptoms can overlap with those of other more common conditions. Remission rates in the postoperative vary between 55–85%. Overall, the mean time to diagnosis was 38 months. The objective of this study was to describe whether there is any pre-surgical clinical data that predicts CD remission after TSS.
Patients and Methods: Retrospective analysis of patients who underwent as TSS for CD. Variables analyzed: age, sex, time to diagnosis, tumor size, serum cortisol, salivary cortisol, urinary-free cortisol (UFC), remission of CD. Remission was defined as normalization of serum cortisol, salivary cortisol and UFC levels.
Results: 67 patients with CD treated with TSS. 42.45 ± 14 years old. Women: 82.1%. Macroadenomas 49.3%. Remission 71.6% (men: 3; women 45). Persistence 28.4% (men: 9; women 10). Presurgical treatment (76.2%): 44 patients with ketoconazole, 1 patient with cabergoline and 6 patients with combination of both (remission: 84.8%, persistence: 57.9%; P = 0.04). Recurrence: 23.9%. Death 4.5% (n = 3).
| Remission | Persistence | P | |
| Age (years) | 41.17 ± 14.82 | 45.68 ± 13.24 | 0.7 |
| Time from onset of symptoms to diagnosis (months) | 34.52 ± 28.96 | 23.33 ± 29.75 | 0.2 |
| Time from diagnosis to surgery (months) | 6.5 ± 5.6 | 5.7 ± 3.37 | 0.5 |
| Tumor size (mm) | 9.35 ± 6.87 | 20.47 ± 9.55 | 0.001 |
| Basal cortisol (µg/dl) | 23.6 ± 10.64 | 22.10 ± 9.37 | 0.6 |
| Midnight plasma cortisol (µ g/dl) | 14.52 ± 5.38 | 34.6 ± 32.47 | 0.015 |
| Midnight salivary cortisol (µg/dl) | 2.75 ± 6.71 | 0.74 ± 0.56 | 0.04 |
| 24-hour urinary cortisol (µg/24 h) | 586.23 ± 678.55 | 277.42 ± 190.41 | 0.05 |
| ACTH (p g/ml) | 81.14 ± 50.5 | 81.8 ± 72.12 | 0.96 |
Conclusions: Remission is more frequent in women and in patients with pre-surgical treatment. In the presurgical study, patients in remission had smaller tumors and lower cortisol levels at midnight, however they had higher levels of CLU.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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