Endocrine Abstracts

JOINT304

Background: Cushing’s disease (CD) is a rare condition with variable surgical outcomes. This study aimed to assess remission and recurrence rates in CD patients undergoing transsphenoidal surgery (TSS) in a contemporary cohort at a major referral center in Israel, and to identify predictive factors for these outcomes. We anticipated that microadenomas would have higher remission rates than macroadenomas.

Methods: This was a retrospective analysis of 97 CD patients who underwent TSS at Tel Aviv Sourasky Medical Center from 2002 to 2022. Remission was defined by a set of biochemical criteria and clinical improvement. Suspected recurrence was confirmed by pathological dexamethasone suppression and/or an elevated urinary free cortisol. Univariate and multivariate analyses were used to identify predictors of remission, while Kaplan-Meier survival analysis and Cox proportional hazard modeling were employed to determine factors associated with recurrence.

Results: The overall remission rate was 63.9%, 69% for first time surgery, and 30.7% for repeat TSS. Contrary to our hypothesis, remission rates were similar between microadenomas (58.7%) and macroadenomas (73.5%), P = 0.148. By multivariate logistic regression, predictors of remission were adenoma presence in pathology specimens (OR=31.25, P < 0.001) and first-time surgery status (OR=9.42, P = 0.002), while a younger age seemed to play a contributory factor (OR=0.963, P = 0.05). The overall relapse rate was 22.6% over a median follow-up of 63 [IQR 35-109.5] months. Of all the variables considered, glucocorticoid withdrawal syndrome (GWS) emerged as a novel, and the only significant apparent protective factor against recurrence (P = 0.045).

Conclusions: This study, the largest and most up-to-date analysis of short and long-term TSS outcomes for CD in Israel, is somewhat at odds with some established notions about remission predictors, including the initial hypothesis about microadenomas. Likewise, the identification of GWS as a novel predictor of long-term remission, requires confirmation, but could provide a potential avenue for post-operative monitoring and follow-up care in the local context. Moreover, it highlights the necessity to assess outcomes at the patient, and local healthcare-specific level.