Endocrine Abstracts

Background: Cushing’s disease is characterized by chronic ACTH hypersecretion, leading to hyperplasia of the adrenal zonae reticularis and fasciculata and, therefore, increased secretion of cortisol, androgens and DOC. Cushing’s disease is the most common form of Cushing’s syndrome, being responsible for approximately 80% of reported cases.

Aim: To evaluate the curability rate of Cushing’s disease 1 year postoperatively.

Subjects and methods

We studied retrospectively 28 patients from our Endocrinology department, between 2016–2017, with Cushing’s disease: 14 patients that were treated by transsphenoidal adenomectomy and 14 patients by bilateral adrenalectomy, with and without radiation therapy and medical treatment.

Results: 77% of the subjects were women and 23% were men. Age of the patients was between: 30–40 years (13%), 41–50 years (40%), 51–60 years (16%), 61–70 years (23%), 71–80 years (8%). 29/30 patients presented clinical features suggestive of cortisol hypersecretion: red to purple striae (53%), facio-cervico-truncal obesity (83%), hirsutism (40%), hypertension (73%) and diabetes (26%). Patients treated by transphenoidal adenomectomy had the following outcome: 57% had microadenomas that were cured postoperatively, 43% remaining had macroadenomas, of which: 66% were resistant to combined treatment- surgery, gammaknife radiation therapy and medical treatment with steroidogenesis inhibitors, somatostatine analogs or dopamine agonists and 34% were cured postsurgery. Patients with bilateral adrenalectomy: 79% cured postoperatively, of which 35.7% also underwent radiation therapy and 21% controlled after bilateral subtotal adrenalectomy combined with radiation therapy and medical treatment.

Conclusions: The elective treatment for Cushing’s disease is removal of the pituitary adenoma, by transsphenoidal adenomectomy, which has a high rate of curability, predominantly when dealing with microadenomas. Bilateral adrenalectomy is a secondary treatment option, that cures Cushing’s disease, but at the cost of adrenal insufficiency.