Endocrine Abstracts

Introduction: Cushing disease (CD) is the leading cause of endogenous hypercortisolism, caused by a pituitary tumor that produces ACTH. Treatment modalities include transsphenoidal selective adenomectomy (TSA), pharmacological therapy, radiotherapy (RT), and bilateral adrenalectomy (BA). The goal of our study was to analyze the outcomes of Cushing disease treatment in UHC Zagreb.

Method: This retrospective study comprised 64 patients with CD (51 (80% women), the median age of 39 (16-70 years) treated in the Department of Endocrinology at UHC Zagreb from 2005 to 2022.

Results: After TSA, 53 (83%) of patients achieved remission, but four patients developed relapse during the follow-up (the median time to relapse was 21.5 (5-144) months). Eleven patients who did not achieve remission after TSA and four patients with relapse were introduced to the other treatments: ketoconazole (9 patients), metyrapone (2), gamma-knife RT (3), and BA in two patients, resulting in remission in ten patients. Among patients with the active disease after surgery, one patient died, another one was lost to follow-up, and one patient still has active disease. Furthermore, additional two patients with relapse were lost to follow-up. After all treatment modalities, we accomplished remission in 92% of patients.

Conclusion: The main goals of CD treatment should be the achievement of remission and timely relapse detection. Despite all treatment options, managing patients with CD remains challenging, and patients’ motivation for long-term follow-up is an important issue.