Endocrine Abstracts

To estimate the point prevalence of active Cushing’s disease (CD) in Belgium, all endocrinologists were invited to perform a retrospective chart review of the CD patients they had been treating between 1-1-2009 and 31-12-2010.

Only patients requiring cortisol lowering therapy because of cortisol excess could be included, such as de novo patients (n=53), previously diagnosed patients with persisting/recurrent disease after pituitary surgery and/or radiotherapy (n=27) or on primary or no medical therapy (n=13) and finally patients with previous surgical remission but relapsing in 2009 or 2010 (n=9). Other CD patients in remission or controlled without cortisol lowering therapy, e.g. those with bilateral adrenalectomy, were excluded.

The mean age at time of diagnosis of these 102 subjects (82% female) was 45±15 yrs. The annual incidence of CD based on the de novo cases in 2009 and 2010 was 2.14 (95%CI: (1.36; 3.21)) and 2.77 (1.87; 3.95) per million inhabitants, respectively.

Over the two years period 57 pituitary surgeries were reported in 53 patients, followed by surgical remission in 79%. Remission rate (combined early remission and delayed control) was 72% in 46 first procedures and 82% in 11 repeat surgeries.

At the end of the observation period, 33 of 49 patients diagnosed before 2009 were still active. One had died while 15 were in remission after first (7) or repeat (7) pituitary surgery or after adrenalectomy (1). Of the newly diagnosed patients 30 were in surgical remission (following pituitary surgery in 26 and adrenalectomy in 4). After exclusion of another death, 22 new patients still had active CD on 31-12-2010, although in 13 of these, first surgical treatment had yet to be performed.

These data result in an estimated point prevalence of active CD on 31-12-2010 of 5.0 per million (95%CI (3.7; 6.5)), based on the entire Belgian population on that date.

This retrospective epidemiological study provides insight in the number of CD patients that might need additional treatment, including steroidogenesis inhibitors or pituitary-targeted drugs, when (repeat) pituitary surgery fails.

Could be candidates for treatment with the new pituitary-targeted drug pasireotide.

○ Audits should describe the patient population, audit methodology, and outcomes which should encompass any change/benefit to clinical practice.