Medium-term effects of surgical therapy vs. medical treatment in patients with remission of cushing

Ylenia Alessi; Luca Balbo; Rosalinda Casablanca; Angela Alibrandi; Angileri Filippo Flavio; Giraldi Francesca Pecori; Francesco Ferrau; Salvatore Cannavo

doi:10.1530/endoabs.110.P938

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Endocrine Abstracts (2025) 110 P938 | DOI: 10.1530/endoabs.110.P938

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Medium-term effects of surgical therapy vs. medical treatment in patients with remission of cushing’s disease

Ylenia Alessi ^1,2 , Luca Balbo ³ , Rosalinda Casablanca ³ , Angela Alibrandi ⁴ , Filippo Flavio Angileri ¹ , Francesca Pecori Giraldi ² , Francesco Ferraù ^3,5 & Salvatore Cannavò ^3,5

Author affiliations

¹Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy; ²Department of Clinical and Community Sciences, University of Milan, Milan, Italy; ³Endocrine Unit, “Gaetano Martino” University Hospital of Messina, Messina, Italy; ⁴Department of Economics, University of Messina, messina, Italy; ⁵Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy

JOINT3399

Cushing’s disease (CD) is associated with high morbidity and mortality if not adequately treated. The first-line therapy is transsphenoidal surgery (TSS), where indicated, followed by medical therapy and/or radiotherapy and/or bilateral adrenalectomy based on clinical context. The aim of this study was to evaluate any differences in anthropometric, clinical, hormonal, and metabolic parameters, including CD-related comorbidities, between patients who achieve remission after surgical therapy (group S) and those who achieve it through medical therapy (group P), also stratifying them by sex.

Methods: We retrospectively assessed 47 patients with CD (37 women), all treated with TSS except for 2, followed at the Endocrinology Unit of the AOU of Messina from 2014 to 2024; of these, 33 achieved remission after surgery (27 women) and 14 after medical therapy (10 women). Parameters were evaluated before surgery and/or medical therapy (T0) and one year after disease remission achieved through surgery or medical therapy (T1).

Results: At T1, patients in group S compared to T0 showed a significant reduction in waist circumference (WC), transaminase levels, glycated hemoglobin, serum cortisol, urinary free cortisol (UFC), ACTH, DHEAS, an improvement in cardiovascular comorbidities, and a higher incidence of central hypothyroidism. In contrast, patients in group P, compared to T0, showed significant reductions in ACTH, serum cortisol, and DHEAS without significant differences in terms of comorbidities. When comparing the two groups at T1, patients in group S had significantly lower values of WC, triglycerides, and serum cortisol and a significantly reduced prevalence of striae rubrae, easy bruising, hypertension, and cardiomyopathy, compared to patients in group P. After stratification by sex, at T1: males (M) in group S showed lower total and LDL cholesterol values and a higher incidence of hypogonadism and GHD compared to females (F); in group P, males had a higher incidence of cardiomyopathy, hypogonadism, and diabetes compared to females.

Conclusion: One year after remission of CD, patients in surgical remission showed a significant improvement in some typical disease signs and cardiometabolic profile compared to the pharmacological remission group. Additionally, after stratification by sex, in the pharmacological remission group, M showed a poorer cardiometabolic profile than F.