Introduction: Cushing disease (CD) results from excessive exposure to glucocorticoids caused by an adrenocorticotropic hormonesecreting pituitary tumor. Inadequately treated CD is associated with significant morbidity and elevated mortality.
Objetive: The study purpose was to describe the long term treatment outcomes for CD patients in our hospital.
Methods: Retrospective analysis of the records of 36 patients with Cushing disease with more than 5 years of follow up. Descriptive statistical analyses were conducted to examine presenting signs, laboratory data and treatment outcomes.
Results: 75% were female, median age at diagnosis 39.7 years (range:1272 years). Pituitary adenomas size were 320 mm, 69.6% microadenomas, 21.7% macroadenomas. Blood test: Mean ACTH 68.04 pg/ml(normal range 552 pg/ml), 50%>52 and 50% <52 pg/ml. 85.7% had positive dexametasone 1 mg supresión test, 71.4% positive 8 mg supression test, 86.4% elevated UFC, 66.7% elevated salival nocturnal cortisol. 15% of patients had 3 positive test, 65% 2 positive test. Inferior petrosal sinus sampling (IPSS) were needed in 34.2%. First line Treatment: 100% underwent TSS (transesphenoidal surgery). The remission, recurrence and persistence rate were: 36.4%, 36.4% and 27.3% respectively. Remision rate after normal anatomopathology was 57.1%. Remission rates: in patients <30 years old remision rate was 12.5% vs >30 years 50%, micro 41.7% vs macro 33.3%,women 43.8% vs men 16.7%, early postsurgery cortisol<10 μg/dL 100% vs cortisol >10 μg/dL 12.5%. Mean time between first treatment and first recidive: 6.7 years. Non cured patients in first line treatment: Mean time between second treatment and second recidive: 11.5 years. 70% had normal conventional RM and were diagnosed with ·3T RM/metionin PET, 69.2% underwent second TSS and 30.8% radiotheraphy. Remission, recurrence and persistence rate after second line treatment were: 50%, 7.1% and 42.9% respectively. After all treatments 68.2% are cured (13.3% with panhipopytuitarism)and 31.8% are non cured, with ketokonazol and waiting for definitive treatment).
Conclusion: Despite multiple treatments, at the end of follow-up, remission was still not achieved in 31.8% of patients. Early possurgery cortisol is the best predictor of remission after surgery.
19 May 2018 - 22 May 2018