Barriers to timely diagnosis of cushing

Tamara Dojcinovic; Pancic Jelena Malinovic; Bojana Caric; Aleksandra Markovic

doi:10.1530/endoabs.110.EP1288

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Endocrine Abstracts (2025) 110 EP1288 | DOI: 10.1530/endoabs.110.EP1288

ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)

Barriers to timely diagnosis of cushing’s disease in the outpatient setting

Tamara Dojcinovic ¹ , Jelena Malinovic Pancic ^1,2 , Bojana Caric ^1,2 & Aleksandra Markovic ^1,2

Author affiliations

¹University Clinical center of the Republic of Srpska, Medical faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; ²School of medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

JOINT1414

Introduction: Cushing’s disease is a rare condition, particularly when compared to Cushing’s syndrome, with an incidence of 0.7 to 2.4 cases per million individuals. Due to its rarity, diagnosis is frequently delayed, which results in a notable increase in morbidity. First line treatment is pituitary surgery, and remission in obtained in 80% of patients with microadenoma, and 60% of those with macroadenoma. In the event of failure of surgical treatment, and if reoperation is not feasible, the introduction of steroidogenesis inhibitors and radiotherapy may be considered.

Case report: We present the case of 38-year-old female patient with hypercorticism which was reffered to our institution from outpatient endocrinologist. She was diagnosed with diabetes mellitus type 2 at the age of 33, and hypertension at the age of 30. Due to irregular mestrual cycles, she was followed by endocrinologist and gynecologist as a polycistic ovary syndrome. At the age of 38, due to worsening of diabetes and obesity, her outpatient endocrinologist obtained Dex screening cortisol levels which were unsupressed, and reffered her for further testing. We did extensive hormonal work up which confirmed ACTH dependent hypercortisolism. Pituitary NMR showed pituitary macroadenoma sized 3,1 cm. The patient also presented with an adrenal incidentaloma, and subsequent evaluation confirmed the presence of a nonfunctional tumor with radiological characteristics consistent with an adenoma. She was operated on by experienced neurosurgeon, and postoperative follow up comfirmed that did not achieve remission, and since tumor invaded cavernous sinus, gama knife was performed. Subsequently, patient in still not in remission regarding Cushings disease, while she has well controlled diabetes and hypertension.

Conclusion: In conclusion, as previously mentioned, the diagnosis of Cushing’s disease is frequently delayed due to its rarity, particularly in less experienced centers. Consequently, in young women presenting with amenorrhea and diabetes, secondary causes of diabetes should be considered to ensure timely diagnosis and appropriate treatment.