Endocrine Abstracts

Introduction: The main goal of treatment in Cushing’s disease (CD) is to induce remission as well as to restore reproductive function. We aimed to evaluate the reproductive status of the female patients with CD encountered in sexually active patients after surgical with/without medical treatments.

Method: The retrospective data was obtained from the medical records of the 72 female patients diagnosed with CD at hospital registration system. The patients were contacted on 8/2022 by phone and were asked about their CD and reproductive histories. Two patients having a history of TAH-BSO, 15 individuals who could not be reached by phone, and three dead patients were excluded from the study.

Results: Six of the patients were single at the time of the research, so no further inquiries regarding fertility status were made. At the time of the diagnosis, 39 of the females were premenopausal. Thirty premenopausal patients were followed in remission. In terms of the number of pregnancies before CD diagnosis, 33 sexually active individuals had 72 pregnancy and 60 live births. Before CD diagnosis, two patients had attempted in vitro fertilization (IVF) once, and one patient had attempted IVF twice. Four IVF attempts resulted in three pregnancies and one live birth. Twenty four patients had no pregnancy loss, six patients had one pregnancy loss, and three patients had two pregnancy losses. During the post-treatment period, hypogonadism was detected in 12 of 33 premenopausal individuals following CD treatment. Six of the 33 patients were using contraception. Eleven patients wanted to get pregnant. Twenty seven contraceptive-free patients had a history of ten pregnancies, seven live births, and two pregnancy losses. Two patients experienced miscarriage once. Two (7%), one (%3.7), and one (3.7%) couples underwent IVF once, four and five times, respectively. The number of pregnancies and live births during the remission period of CD were reduced, while the frequency of miscarriage was the same.

Conclusion: While current therapies achieve remission in the majority of the patients, they do not contribute to the formation of adequate reproductive functions despite the improved infertility treatment procedures. Endocrinologists’ and pituitary surgeons’ incorrect assumption of the low possibility of achieving pregnancy rates even if remission is achieved, should be corrected, and refer patients with CD at the correct time without delay for assisted reproductive procedures if necessary.