Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2011) 25 P229

SFEBES2011 Poster Presentations Pituitary (41 abstracts)

20 year experience in the surgical management of cushing’s disease in a UK tertiary referral centre

Zaki Hassan-Smith 1 , Alan Johnson 2 , Andrew Toogood 1 , Wiebke Arlt 1 , Mark Sherlock 1 & Paul Stewart 1


1University of Birmingham, Birmingham, UK; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Objective: The past 2 decades have seen advances in the surgical management of Cushing’s disease (CD). Our aim was to meet the need for current data on clinical features, long-term outcomes, and prognostic indicators.

Patients and methods: We conducted a retrospective study of 71 patients treated by trans-sphenoidal surgery (TSS) for CD. All patients were operated on by the same surgeon in a single centre between 1988–2009. Diagnosis was confirmed using Low and high dose-DSTs, and CRH tests, with selected patients undergoing IPSS. 58 patients underwent microscopic-TSS at first surgery, whereas 13 had Endoscopic-TSS.

Results: Median follow up was 50 months (IQR 22–115 months). Median age at diagnosis was 39 years (IQR 30–50 years). Male:female ratio was 1:3.4. Follow up data were available on 67/71 patients. 82% (55/67) achieved initial clinical remission, of which 8 suffered disease recurrence. Mean time to recurrence was 3.9 years (IQR 3 months-14 years). 3 outcome groups were identified: ‘Long-term Cure’ 70% (47/67), ‘Persistent Disease’ 18% (12/67), and ‘Recurrent Disease’ 12% (8/67).

Long-term cure rates were higher in patients with undetectable (<30 nmol/l) post-operative cortisol levels (87%). They were also increased in patients with histology positive for ACTH-containing adenomas (82%), compared to those with negative histology (57%). Further treatment for patients with recurrent/persistent disease included revision TSS (n=11), Radiotherapy (n=7), and Adrenalectomy (n=7). Common complications following TSS were transient DI (60%), and CSF leak (16%). Hypopituitarism was present in 81% of patients at final follow up. Mortality was increased in persistent/recurrent disease, compared to the long-term cured (P=0.04). 4 deaths were documented (2 recurrent, 1 persistent disease, 1 cured 20 years previously).

Conclusion: Our favourable remission/cure rates, serve to underline the importance of an experienced surgeon in the management of CD. Favourable prognostic factors include undetectable post-operative cortisols and ACTH-positive histology. The reduced mortality in the long-term cured, demonstrates the importance of aggressive treatment of CD.

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