title: Management of Cushing's disease: a single-center experience.
abstract: The purpose of this study was to review therapeutic outcomes and comorbidities of patients with Cushing's disease (CD) in a single center. We conducted a retrospective study of 33 patients with CD undergoing transsphenoidal surgery from January 2007 to February 2014 (27 females and 6 males, median age 38 years, range 18-71 years). The diagnosis of Cushing's syndrome was established on the basis of the patient's history, characteristic clinical features, and laboratory data including an elevated 24-h urinary free cortisol level, lack of serum cortisol suppression after dexamethasone suppression tests and an elevated midnight cortisol level. In 28/33 patients, the tumor was visualized on MR of the sellar region, while in 5 it was diagnosed using an inferior petrosal sinus sampling. Out of the 33 patients, 10 had macroadenoma and the remaining 23 had microadenoma. Twenty-one patients (63.6%) had hypertension, 17 (51.5%) dyslipidemia, and 7 (21.2%) had type 2 diabetes or impaired glucose tolerance. The median follow-up period was 28 months. Remission after transsphenoidal surgery was achieved in 78.8% of patients, while 7 patients failed to achieve disease remission. Those patients were treated with second-line treatment modalities (second operation, radiotherapy, bilateral adrenalectomy, and/or ketoconazole). One patient rejected all the treatment modalities after surgery. Cumulative remission after all the treatment modalities was achieved in 87.9% patients. Patients with Cushing's disease should be managed in centers with much experience due to high patient load. In our Center, the remission of the disease has been achieved in 78.8% of the patients following transsphenoidal surgery. Multimodal treatment which included radiotherapy and medical treatment led to biochemical remission of the disease in 87.9% of patients.
authors.affiliation: Department of Endocrinology, Center of Neuroendocrinology Zagreb, University Hospital Center, Zagreb, Croatia. mirsala.solak@gmail.com.
authors.forename: Mirsala
authors.initials: M
authors.lastname: Solak
authors.affiliation: Department of Endocrinology, Center of Neuroendocrinology Zagreb, University Hospital Center, Zagreb, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kraljevic
authors.affiliation: Department of Endocrinology, Center of Neuroendocrinology Zagreb, University Hospital Center, Zagreb, Croatia.
authors.forename: Tina
authors.initials: T
authors.lastname: Dusek
authors.affiliation: Department of Neurosurgery, Center of Neuroendocrinology Zagreb, University Hospital Center, Zagreb, Croatia.
authors.forename: Ante
authors.initials: A
authors.lastname: Melada
authors.affiliation: Department of Otorhinolaryngology, University Hospital Center, Zagreb, Croatia.
authors.forename: Marcel Marjanovic
authors.initials: MM
authors.lastname: Kavanagh
authors.affiliation: Department of Neurosurgery, Center of Neuroendocrinology Zagreb, University Hospital Center, Zagreb, Croatia.
authors.forename: Vjerislav
authors.initials: V
authors.lastname: Peterkovic
authors.affiliation: Department of Radiology, University Hospital Center, Zagreb, Croatia.
authors.forename: David
authors.initials: D
authors.lastname: Ozretic
authors.affiliation: Department of Endocrinology, Center of Neuroendocrinology Zagreb, University Hospital Center, Zagreb, Croatia.
authors.forename: Darko
authors.initials: D
authors.lastname: Kastelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D003907:Dexamethasone / Q000494:pharmacology; D019468:Disease Management; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010911:Pituitary Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone
keywords: Comorbidity; Cushing’s disease; Pituitary adenoma; Remission; Transsphenoidal surgery