SFEBES2021 Poster Presentations Late Breaking (60 abstracts)
Long-term Clinical Outcomes for Cushing’s Disease: experience of the multi-disciplinary team at the Royal Victoria Infirmary
Nesta Baxter 1 , Mona Abouzaid 2 , Andy James 2 , John Hill 2 , Sean Carrie 2 , Claire Nicholson 2 , Alistair Jenkins 2 , Isma Iqbal 2 , Ian Coulter 2 , Richard Quinton 2 & Yaasir Mamoojee 2
1Newcastle University Medical School, Newcastle Upon Tyne, United Kingdom;2Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
Objective: Standard Cushing’s disease (CD) treatment is trans-sphenoidal surgery (TSS). However, reported postoperative remission and relapse rates are variable. We have retrospectively analysed clinical outcomes of patients with CD undergoing TSS at our centre.
Methods: Patients with CD currently under our long-term endocrine care were included. Diagnosis of CD was made following standard biochemical and radiological investigations. Post-operative remission criteria: suboptimal synacthen testing and ongoing steroid replacement or normal 24-hour urine free cortisol and/or overnight dexamethasone suppression test.
Results: 48 patients were eligible. Mean age at presentation was 43 years (range 14–69), with a female preponderance of 73%. Mean clinical follow-up duration was 12 years (range 1–39). Available initial MRI for 38 patients identified 17 (46%) macroadenoma (>1 cm), 15 (40%) microadenoma, remaining 14% either normal, bulky or empty sella. 46 patients underwent TSS with a 58% remission rate. 16/27 (59%) subsequently suffered biochemical relapse. Remission rate after 2nd TSS was 45%. After 1st TSS 17 patients had persistent CD, 9 underwent further TSS with 33% remission rate post-surgery. After 1st TSS, remission rate in those with microadenoma was higher (66%) than in the macroadenoma cohort (52%). At latest follow-up, 19 (41%) patients remained in remission after ≥1 TSS. Further treatment modalities in those with persistent/relapsed CD included radiotherapy (12), bilateral adrenalectomies (3) or both (9). Incidence of pituitary hormonal losses were lower in patients with ongoing remission following 1st TSS than in those who suffered persistent/relapsed CD: hypoadrenalism (18% cf. 64%), hypothyroidism (27% cf. 57%) and hypogonadism (22% cf. 57%) (P < 0.05).
Conclusions: We observed a CD remission rate with ≥1 TSS of 41% over a mean follow-up period of 12 years. Further treatment of relapsed/persistent CD following 1st TSS is complicated with a high incidence of pituitary hormonal losses.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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