AACE2021-A-1094: Clinical Profile and Treatment Outcome in Patients with Cushing Syndrome: a 15-Year Experience at a Tertiary Care Hospital in Pakistan

Abstract

Cushing’s Syndrome (CS) results from chronic exposure of body to excessive production of glucocorticoids. Etiology of CS may lie in the adrenal gland, pituitary gland (Cushing Disease, CD), or ectopic ACTH production by certain malignancies. Surgical excision of culprit lesion remains the most effective procedure. To the best of our knowledge, this important endocrinal entity of CS had never been researched in Pakistan. This descriptive cohort study was conducted at Aga Khan Hospital, Karachi. Data of patients with biochemical and radiological diagnosis of Hypercortisolism presenting between January, 2005 to December, 2019 was reviewed. Patients with history of intake of Glucocorticoids were excluded. Of the 50 subjects, with mean age of 34.72 ± 13.83 years, 33 (66%) were female while 17 (34%) were male.The mean duration of presentation was found to be 1.94 ± 1.83 years after onset of symptoms. Weight gain was the most common presenting complaint. Pituitary lesion was the culprit source in 38 (76%) cases, ectopic ACTH source in 8 (16%) cases and adrenal lesion in only 4 (8%) cases. Among the 38 patients with CD, 30 (79%) underwent TSS and 14 (47%) attained remission. Among the 8 patients with Ectopic ACTH source, only 1 (12.5%) underwent surgical excision and attained remission while 3 patients attained remission with medical treatment only. Out of the 4 patients with Adrenal source, 3 (75%) underwent uni/bilateral adrenalectomy and all (100%) attained remission. Pituitary lesion is the most common source of endogenous hypercortisolism. TSS is followed by a relatively low remission rate of 47% as compared to the developed world.