Endocrine Abstracts

Introduction: Transsphenoidal surgery is the gold standard in Cushing’s disease and recurrence is a major risk. We wondered which impact remission and recurrence might have on control rates of hypercortisolism and conducted a systematic analysis of our cohort of patients with Cushing’s syndrome after undergoing surgical therapy.

Methods: We analysed the course of the disease in 74 patients with ACTH-dependent Cushing’s syndrome (63 Cushing’s disease (CD); 11 ectopic Cushing’s syndrome (ECS)). All patients underwent surgery as first line therapy and in cases where relapse occurred, each received further therapy. The outcomes of interest were biochemical remission/control, clinical remission and recurrence, with evaluations conducted annually from the time of first treatment (follow-up time: 1–38 years).

Clinical remission was defined by the absence of Cushing stigmata. Biochemical remission/control was defined as normal urinary free cortisol levels, normal salivary cortisol levels at midnight and/or cortisol <1.8 μg/dl after 1 mg overnight dexamethasone suppression test. Data analysis was conducted using the Kaplan-Meier method.

Results: In patients with CD the biochemical control rates at 1, 2 and 3 years were 77.2, 81.8, and 77.2%. In contrast, patients with ECS showed considerably higher remission rates with 88.8% at 1 year and 100% at 2 and 3 years. The cumulative recurrence free remission rate in CD was 71.4% at 1 and 2, and 54.2% at 5 years. In patients having second transsphenoidal surgery the remission rate was poor with 50% at 1 and 2 years, and 40% at 5 years.

Conclusions: The outcome of patients in remission 1 year after initial surgery is associated with higher remission rates in the long term, while the absence of remission after 1 year, or the occurrence of early relapse are related to a noticeably poorer outcome.