Endocrine Abstracts

Background: Successful pituitary surgery in patients with Cushing disease (CD) can result in long term remission and sustained weight loss. We examined rates of body weight changes in the post-operative period (within 6 months) in patients with active CD who underwent transsphenoidal surgery (TSS) and the relationship of weight loss to remission status.

Methods: Clinical data was obtained from a CD database in addition to an online patient medical record (EPIC). All patients with biochemically confirmed active CD underwent their first TSS by a single neurosurgeon at the Cleveland Clinic (October 2004–August 2013). No patients received glucocorticoids during surgery. Initial remission was defined by nadir cortisol <3 ng/dl, ACTH <5 pg/ml within the immediate post-operative period (72 h). Long term remission was defined as 24 h UFC <ULN (upper limit of normal), and/or sequential midnight salivary cortisols <ULN, and 1mg DST cortisol <1.8 μg/dl.

Results: 88 patients (female: 63, male: 25), with a mean age at presentation of 47 years (range 24–87 years), median follow up 52 months (12–118 months) underwent TSS. No significant differences in baseline demographics including pituitary adenoma size (P=0.25) and BMI (P=0.21) were observed between the two groups. 64: pituitary microadenoma, 24: macroadenoma, 74 (84%) patients had initial remission after surgery, during follow up six of those with initial remission had recurrence. Those with initial remission had greater mean±S.D. weight loss at 3 months (kg:−8.1±11.3 (initial remission, n=59) v 0.8±8.8 (non-remission, n=12), P=0.007) and at 6 months (kg:−14.5±12.1 (initial remission, n=46) v −6.1±12.1 (non-remission, n=12), P=0.045). Less weight loss or weight gain at three (P=0.002) and six (P=0.014) months was associated with increased relapse risk.

Conclusions: After TSS for CD, weight loss within the first 6 months is an additional early clinical indicator associated with initial biochemical remission.