Experience Of Surgical Treatment And Follow-up Of Cushing's Disease

ObjectivesCushing's disease is a subtype of Cushing's syndrome,which is caused by an adrenocorticotropic hormone(ACTH)-secreting pituitary adenoma.Untreated Cushing's disease may lead to chronic hypercotisolism,involving multiple systems and resulting in excess mortality.The first-line therapy for Cushing's disease is transsphenoidal surgery to remove tumor.The factors may influence initial surgical outcome and long-term outcomes are not well-understood.Long-term results of large series are badly in need.Meanwhile,the follow-up system of Cushing's disease is incomplete.Based on pituitary adenoma database,this study constructed long-term follow-up system of Cushing's disease,and analyzed initial and long-term results of a large series of patients with Cushing's disease.Methods1494 medical records were reviewed for patients treated with surgery for Cushing's disease from 1978 to 2017 in a single center.New designed standard follow-up system was used to renew the 951 insufficient follow-up records.Excluding the insufficient records and ectopic ACTH syndrome,a total 1213 patients were included for recordingage,BMI and clinical features.1035 patients whose radiographic,pathological and follow-up data were available were further analyzed for the surgical efficacy and long-term results.Patients were categorized for statistical analysis based on tumor size(microadenomas,macroadenomas,giant adenomas,and negative imaging)and post-operative nadir morning cortisol level(morning cortisol?2?g/dl;2-5?g/dl;5-22?g/dl;?22 ?g/dl).ResultsThe success rate of standardized telephone follow-up was 36%,and 74.14%of patients with successful follow-up kept long-term remission.The main reason for the failure of telephone follow-up was the changed phone number(74.75%).Female comprised 82%of enrolled patients and were older than men.Imaging showed 72%microadenomas,15.5%macroadenomas,1.5%giant adenomas and 10.5%negative for tumor.Remission rates for microadenoma,macroadenoma,and negative imaging were 79%,72%,31%and 71%,respectively.Patients with microadenomas were more likely to have initial remission.Pathology showed ACTH-secreting adenoma in 88%of microadenoma,in 95%of macroadenoma,in 100%of giant adenoma and in 79%of negative imaging.The incidence of hyperplasia was 3%.The finding of hyperplasia or negative on pathology predicted surgical treatment failure.The long-term remission of microadenoma is better than that of macroadenoma.Immediate postoperative low cortisol levels predicted better long-term outcomes.But lower cortisol levels failed to achieve better long-term outcomes.ConclusionsTelephone follow-up is an available method for long-term follow-up of Cushing's disease.Postoperative follow-up won't help patients keep long-term remission,but it may improve the postoperative survival of patients,and medical centers should be more initiative in follow-up.Surgical treatment is an effective treatment for Cushing's disease,and patients with microadenoma and immediate postoperative hypocorticosis seem to have better long-term outcomes.