Efficacy analysis of diagnosis and treatment of Cushing's disease with a multidisciplinary team

Abstract

Listen

Translate article

Objective To analyze the efficacy and experiences of the diagnosis and treatment of Cushing's disease with a multidisciplinary team. Methods Forty-five patients with Cushing's syndrome treated under the MDT diagnosis and treatment process mode at Shanghai Huashan Hospital, Fudan University from January to December 2013 were analyzed retrospectively. Among the 45 patients, 22 underwent bilateral inferior petrosal sinus blood sampling, and 40 were diagnosed as Cushing's syndrome. Macroadenomas, microadenomas, and MRI negative were 8, 26, and 6, respectively, 3 of them were invasive. Thirty-two patients were newly diagnosed, 8 relapsed or did not relieve after the first treatment.Their diagnosis, management, efficacy, and room for improvement were summarized. Results Thirty-three patients with Cushing's disease received neurosurgery, 32 had transnasal surgery and 1 underwent craniotomy. There was significant difference in the lowest values of serum cortisol at 1 week before and after surgery (869±361 and 60±41 nmol/L respectively; P<0.01). Twenty-two patients had early remission, and 25 had overall remission (76%) at 3 months after surgery; the remission proportions of macroadenoma, microadenoma, MRI negative, and invasive pituitary adenoma were 6/6, 14/18, 3/6, and 2/3, respectively. Of the patients who relapsed or did not relieve after treatment, 6 were reoperated, and 4 were relieved. Of the 27 patients with adrenocorticotropic hormone (ACTH) tumor and 6 with hyperplasia or glandular tissue, 25 and 0 were relieved. Of the 8 patients who were not relieved after surgery, 2 were enrolled into the new drug research of pasireotide, 3 were treated with gamma knife, 1 began to be treated with metyrapone, 1 was waiting for reoperation, and 1 was lost to follow-up. Seven patients had surgical complications. Conclusions The factors affecting surgical treatment of Cushing's disease include the pituitary imaging and pathological features, etc. Under the MDT mode, the diagnosis and treatment help patients to timely choose the optimal treatment regimen. Key words: Cushing disease; Petrosal sinus sampling; Multidisciplinary team