Endocrine Abstracts

Impaired growth hormone (GH) secretion occurs in patients with Cushing’s disease (CD) as a result of cortisol excess. After a surgical treatment, eventually accompanied with radiation therapy, recovery of GH secretion is seen in only variable proportion of patients. According to some studies, it is recommended to perform assessment of GH secretion one to two years after surgical cure of CD. We report a case of a 40-years-old male admitted to the hospital because of sudden loss of consciousness. At the age of 15 years, he was diagnosed with CD and underwent transsphenoidal surgery with the removal of an ACTH-secreting microadenoma. His height at that time was 148 cm, GH was low, with loss of pulsatility. One year postoperatively he received hydrocortison replacement and desmopressin. Three years after, a patient was reevaluated, value of GH was still below reference range, provocative testing using an insulin tolerance test (ITT) was not performed because of epilepsy. According to hormonal testing and petrosal sinus sampling, CD recurrence was diagnosed and radiotherapy successfully applied. After that, a patient has not been motivated for a regular follow-up for almost 20 years. On admission, his height was 165 cm, weight 68 kg (BMI 25 kg/m2), signs of hypogonadism were present. Hormonal examination showed TSH 4.83 mIU/l (0.4-4.0 mIU/l), fT4 4.2 pmol/l (10.3-23.1 pmol/l), GH ˂0.1 ng/ml (0.0-1.0 ng/ml), IGF-1 5 ng/ml (109-284 ng/ml), IGF BP3 0.7 ug/ml (3.4-6.7 ug/ml), FSH 1.8 mIU/ml (0.7-11.1 mIU/ml ), LH 1.6 mIU/ml (0.7-11.1 mIU/ml), cortisol in daily profile 3…2…2 nmol/l. Pituitary magnetic resonance imaging demonstrated an empty sella. Bone mineral density assessed by DXA scan was normal. According to hormonal status, hydrocortisone and thyroxine replacement therapy was started. For the next 5 years, a patient was not followed again. In March 2019, he had an acute myocardial infarction and stent implantation; ejection fraction was preserved. Two months later, on reevaluation, IGF-1 was 29.0 ng/ml (53.3-215 ng/ml), IGF BP3 0.712 ug/ml (3.3-6.7 ug/ml) and GH replacement was finally initiated. During the next months dose adjustment was made (current GH 0.6 ng/ml, IGF-1 227 ng/ml, IGF BP3 4.44 ug/ml). As a result, quality of life and lipid profile are significantly improved (cholesterol 4.48 vs 5.05 mmol/l before treatment, LDL 2.05 vs 2.85 mmol/l, HDL 1.5 vs 1.35 mmol/l). In conclusion, because of multiple long-term benefits, assesment of GH status and GH replacement therapy should be considered in patients with CD in remission.