ECE2023 Poster Presentations Pituitary and Neuroendocrinology (123 abstracts)
Comparison of Clinical, Hormonal, Pathological and Treatment Outcomes of Ectopic ACTH Syndrome by Gender: Results of a Multicenter Study
Sema Ciftci 1 , Nusret Yilmaz 2 , Ozlem Soyluk Selcukbiricik 3 , Zeliha Hekimsoy 4 , Asena Gökçay Canpolat 5 , Senay Topsakal 6 , Guzin Yaylali 6 , Fuat Misiroglu 1 , Nurdan Gul 3 , Ayse Kubat Uzum 3 , Aysa Hacioglu 7 , Goknur Yorulmaz 8 , Hatice Ozisik 9 , Banu Sarer Yurekli 9 , Zafer Pekkolay 10 , Zuleyha Karaca 7 , Cevdet Duran 11 , Medine Nur Kebapci 8 & Sema Yarman 3
1University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Endocrinology and Metabolism, Bakirkoy, Turkey; 2Akdeniz University, School of Medicine, Department of Endocrinology and Metabolism, Antalya, Turkey 3Istanbul University Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey; 4Manisa Celal Bayar University, Department of Endocrinology and Metabolism, Turkey, Manisa, Turkey 5Ankara University School of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey; 6Faculty of Medicine, Pamukkale University, Department of Endocrinology and Metabolism, Denizli, Turkey; 7Erciyes University School of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey; 8Eskişehir Osmangazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Eskişehir, Turkey; 9Ege University Faculty of Medicine, Department of Endocrinology and Metabolism, Bornova, Turkey; 10Dicle University Faculty of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey; 11Medical School of Usak University, Department of Endocrinology and Metabolism, Usak, Turkey
Objective: Data on gender comparisons of diagnosis, management and prognostic factors in Cushing’s disease are very limited, however, there is no such a comparison in ectopic ACTH syndrome (EAS) in the literature. The aim of this study is to compare clinical and hormonal data, neuroendocrine tumor (NET) localization, treatment and survival outcomes in Cushing’s syndrome due to EAS by gender.
Material-Methods: Eleven experienced centers from our country participated in this retrospective study. Clinical and hormonal features, tumor imaging, pathological results, treatment modalities and disease courses of the patients were evaluated.
Results: Fifty-four EAS patients (28 female and 26 male) were reviewed. The mean age at diagnosis is similar as 43±18 years for females and 41±14 years for males. Results of clinical characteristics and hormonal evaluations (ACTH, basal cortisol and 24-h UFC levels and results of dexamethasone suppression test) did not differ in both gender. However, insulin-requiring diabetes mellitus (P=0.04) and osteoporosis with fractures were more common in males (P=0.03). While number of patients with increased DHEA-S levels than upper limit of normal was found to be significantly higher in females (P=0.002), suppressed freeT4 and TSH levels consistent with central hypothyroidism were higher in males (P=0.02). At the diagnosis, 36 NETs (68% of females and 69% of males) were localized. Small cell lung carcinoma was higher in females than in males (P=0.02), the frequency of other NETs (typical/atypical bronchial carcinoid, thymic carcinoid/thymic neuroendocrine carcinoma-NEC, medullary thyroid carcinoma, pancreatic G1-G2 NET/pancreatic NEC and pheochoromocytoma) was not different. Curative surgery was performed on 61% of females and 46% of males. Tumor size, ki-67 labelling index and presence of local lymph node metastasis in pathological examination and distant metastasis rates were similar in both gender. In the follow-up, tumor became visible in 7 of 10 females and 4 of 8 males after medical treatment and/or bilateral adrenalectomy. Tumor could not be detected in 7 patients (3 females, 4 males) during a mean follow-up of 58 months. The overall remission rates (65% of females, 62% of males) and NET-related death rates (14% of females, 30% of males) at the last visit were similar.
Conclusions: While EAS has a similar disease course in many aspects in males and females, hyperglycemia and osteoporosis are more severe in males. Their severity may be due to the reduced beneficial effects of adrenal androgens on bone due to low DHEA-S level and the difficulty of glycemic control by central hypothyroidism.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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