Abstract
IntroductionCushing’s disease (CD) is a rare cause of hypercortisolemia presenting a major diagnostic and therapeutic challenge. Data on pituitary function in long-term follow-up after CD treatment in childhood is limited.AimLong-term assessment of patients of the Children’s Memorial Health Institute (CMHI) after CD treatment in childhood.Materials and methodsRetrospective analysis of 29 CD patients, mean age at the time of diagnosis 13.46 yrs. The long-term follow-up (FU) was done by: 1) obtaining the data from a patient’s questionnaire (75% of adult patients); 2) using the data from the last clinic visit for patients who did not respond to the questionnaire and for current CMHI patients. The average long-term FU from transsphenoidal pituitary surgery (TSS) was 10.23 yrs.ResultsAt the latest FU: 18 patients (62%) had long-term disease remission after TSS1, 2 patients (6.9%) after TSS2, 1 patient (3.4%) after the post-TSS radiotherapy (XRT) cycle and 3 patients (10.3%) after bilateral adrenalectomy (BA). One patient (3.4%) died after TSS2 due to postoperative complications, 1 patient (3.4%) had persistent disease at latest FU, in 1 patient (3.4%) the long-term FU was not possible to perform. CD recurrence occurred in 4 out of 28 patients (14%) at an average time 3.6 yrs. from definitive treatment. One patient (3.4%) after BA was operated because of Nelson's syndrome. Two patients (6.9%) were suspected of relapse at latest assessment. At the time of the last evaluation, 17 patients (63%) were on levothyroxine therapy since definitive treatment, 16 patients (59%) were on hydrocortisone treatment, 10 patients (37%) were taking sex hormones replacement, 4 patients (15%)—antidiuretic hormone.ConclusionsRelatively large number of patients after CD treatment in childhood have hormonal pituitary deficits as well as mood and cognitive disorders. CD recurrence can occur even after a long time post effective treatment.
Highlights
MethodsRetrospective analysis of 29 Cushing’s disease (CD) patients, mean age at the time of diagnosis 13.46 yrs
Cushing’s disease (CD) is a rare cause of hypercortisolemia presenting a major diagnostic and therapeutic challenge
Cushing’s disease (CD) is characterized by excess production of adrenocorticotropic hormone (ACTH) by a pituitary corticotroph adenoma, which results in hypercortisolemia
Summary
Retrospective analysis of 29 CD patients, mean age at the time of diagnosis 13.46 yrs. The long-term follow-up (FU) was done by: 1) obtaining the data from a patient’s questionnaire (75% of adult patients); 2) using the data from the last clinic visit for patients who did not respond to the questionnaire and for current CMHI patients. The average long-term FU from transsphenoidal pituitary surgery (TSS) was 10.23 yrs. Twenty-nine patients (15 girls and 14 boys) were diagnosed with CD and/or treated at Children’s Memorial Health Institute (CMHI), Warsaw, Poland between 1993 and 2018. The average age of all patients at surgery was 13.49 yrs. All but one patient were admitted to the Department of Endocrinology CMHI before surgery. Informed consent was obtained from all patients who completed the questionnaire and Institutional Bioethical Commission (48/KBE/2018) gave permission for the release of anonymized data for publication
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