title: Assessment of the outcomes of the treatment of Cushing's disease in the hospitals of Castilla-La Mancha.
abstract: OBJECTIVE
  Treatment of Cushing's disease poses interesting dilemmas in clinical practice. The aim of our study was to analyze the outcomes of the different treatments, the control and recurrence rates, and the complications derived from them.
  
  
  METHODS
  Data were collected from the clinical records of 22 patients over 18 years of age (86.4% women). They had been diagnosed with Cushing's disease between 2000 and 2012, and were monitored at Complejo Hospitalario Universitario-Albacete, Hospital Virgen de la Salud-Toledo Hospital General Universitario de Ciudad Real, Hospital Virgen de la Luz-Cuenca, Hospital Nuestra Señora del Prado-Talavera de la Reina, and Complejo Hospitalario la Mancha Centro-Alcázar de San Juan.
  
  
  RESULTS
  Surgery was the treatment of choice in all patients. Biochemical cure was achieved in 72.2% of patients. Nine patients developed in the early postoperative period diabetes insipidus, which became in 2 patients only. Surprisingly, 3 patients with normal postoperative neurohypophyseal function later developed permanent diabetes insipidus. New hormone deficiencies occurred in 7 patients. Seventeen patients received ketoconazole before surgery (5 of them after surgery also), and 70% of them achieved normal urinary free cortisol levels. Three patients also received radiotherapy, and all of them were cured after a median follow-up of 85.5 months; they developed no tumors or other complications.
  
  
  CONCLUSIONS
  Our study reports the outcomes of management of Cushing's disease in non-reference centers for this disease, possibly giving a realistic picture of standard clinical practice for the condition in Spain.
authors.affiliation: Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España. Electronic address: ihm.huguet@gmail.com.
authors.forename: Isabel
authors.initials: I
authors.lastname: Huguet
authors.affiliation: Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Aguirre
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Virgen de la Salud, Toledo, España.
authors.forename: Almudena
authors.initials: A
authors.lastname: Vicente
authors.affiliation: Sección de Endocrinología y Nutrición, Hospital Virgen de La Luz, Cuenca, España.
authors.forename: Mubarak
authors.initials: M
authors.lastname: Alramadan
authors.affiliation: Unidad de Endocrinología y Nutrición, Hospital Nuestra Señora del Prado, Talavera de la Reina, España.
authors.forename: Iván
authors.initials: I
authors.lastname: Quiroga
authors.affiliation: Sección de Endocrinología y Nutrición, Hospital La Mancha Centro, Alcázar de San Juan, España.
authors.forename: Julia
authors.initials: J
authors.lastname: Silva
authors.affiliation: Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lamas
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D003131:Combined Modality Therapy; D015897:Comorbidity; D003399:Craniotomy; D003919:Diabetes Insipidus / Q000453:epidemiology / Q000209:etiology; D004724:Endoscopy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007016:Hypophysectomy / Q000379:methods*; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D047748:Pituitary ACTH Hypersecretion / Q000097:blood / Q000209:etiology / Q000628:therapy*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007654:Ketoconazole; D006854:Hydrocortisone
keywords: Cirugía transesfenoidal; Cushing's disease; Enfermedad de Cushing; Ketoconazol; Ketoconazole; Radioterapia; Radiotherapy; Transsphenoidal surgery