The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Clinical outcomes and factors that contribute to long-term remission after pituitary surgery in patients with Cushing’s disease: experience from two Australian Tertiary Hospitals. (#270)

Angeline Shen 1 2 , Helena M Torpy 3 , Liza Phillips 4 , James King 1 , Sourav Das 5 , Christopher Yates 2 , David J Torpy 4 , Peter Colman 2
  1. Royal Melbourne Hospital, Melbourne, VIC, Australia
  2. Dept Diabetes & Endocrinology, Royal Melbourne Hospital, Parkville, Melbourne
  3. The university of Adelaide, Adelaide, SA, Australia
  4. Diabetes and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia
  5. The Epicenter, Melbourne Health, Melbourne, Victoria, Australia

Introduction: Cushing’s disease (CD) is associated with high mortality rate especially with persistent disease. [1, 2] Our aim was to identify predictors of remission using our long-term follow-up data on CD patients.  

Method:  All histories of patients with treated CD at RMH and RAH between 1990-2016 were reviewed.  A binary regression model was used for statistical analysis.

Results: Eighty-seven patients had long term clinical outcome available. Mean follow-up period was 9 years (IQR 2.7-14.4).  Thirty patients (34%) were male and mean age of diagnosis was 45 years (IQR 35-57).  Macro-adenoma were more common in males (50% vs 21%). Osteoporosis rate was highest (50%) in males with low testosterone level (< 6nmol/L). Median weight loss was 10kg at 1 year follow-up (IQR 4-12) but this wasn't sustained in the long-term. After repeated operations, a higher rate of diabetes insipidus  (41% vs 24%, p value=0.04) and CSF leak (11% vs 4%, p value=0.04) were seen but not SIADH (6%). Mortality in the cohort was low (6%).  Remission was achieved in 43 patients (49%) after first surgery and the rate was higher (60%) for surgeries  performed between 2007-2016, although mean follow-up time was shorter: 6.1 years (IQR 1.9-8.7) vs 3.4 years (IQR 1.2-6.3).  Overall, factors associated with achieving clinical remission post initial surgery included: micro-adenoma (OR 8.41, p value=0.03), age > 35 years (OR 4.36, p value=0.01) and initial surgery performed between 2007-2016 (OR 4.9, p value=0.001).  Identification of micro-adenoma on initial MRI (p value=0.31) and level of 24 hour urinary free cortisol (p value = 0.28) weren't found to be associated with clinical outcome.

Conclusion: In our study, higher rates of DI and CSF leak were seen with repeated pituitary operations. Factors associated with remission post initial surgery in long term follow-up include micro-adenoma, age >35 years and operation performed between 2007-2016.

  1. 1. Clayton, R.N., Mortality in Cushing's disease. Neuroendocrinology, 2010. 92 Suppl 1: p. 71-6. 2. Funder, J.W., et al., The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2016. 101(5): p. 1889-916.