Endocrine Abstracts

We present a case series of patients admitted to our hospital with various manifestations of Cushing’s. 71 male, known type 2 diabetes, hypertension referred for adrenal incidentaloma. Cushingoid features with non suppressed ACTH. Low dose dexamethasone test (LDSST): no suppression. 4 cm pituitary microadenoma (likely co-secretory as gonadotropins elevated). Offered IPSS and pituitary surgery. Declined the same due to fears of COVID opted for medical therapy with metyrapone. Patient monitored in clinic with metyrapone titrated to cortisol with follow ups for past 3 years. 81 male admitted with generalized weakness. Hypokalemia and hypocalcemia required monitoring on HDU. Cortisol >1750iU, and no suppression with LDSST. Calcitonin 130 ng/l ACTH 352ng/l. CT metastatic lung malignancy. MRI pituitary Normal. Liver biopsy: Metastatic small cell carcinoma (lung origin). Started on dexamethasone by oncology and planned for chemotherapy. Patient RIP due to sepsis and COVID. 62 male admitted with ?COVID. New diagnosis of diabetes, hypertension and worsening psychosis. Metabolic alkalosis with refractory hypokalemia and hypocalcemia. 24HR Urinary Cortisol 3536 nmol. LDSST: No suppression. ACTH 270 ng/l. MRI Pituitary normal, some lung lesions noted ?source of ACTH. Patient declined bronchoscopy, managed with combination of metyrapone with epleronone for life threatening electrolyte derangement and behavioural issues with good results. We did a meta-analysis of established literature comparing medical management of Cushing’s with comparison of treatment options in terms of medications available and comparison of medical and surgical management of Cushing’s. Eight electronic databases were searched from May-July 2021 with a total of 81 randomized controlled trials and cohort studies. A total of 5631 patients were compiled and we concluded that medical management of Cushing’s particularly in global pandemic such as COVID may be reasonable. No meta-analysis on quality of life was done as lack of evidence, our case series did demonstrate a positive correlation.