Root Cause Analysis of Diagnostic and Surgical Failures in the Treatment of Suspected Cushing’s Disease

Abstract

Background: Cushing’s disease (CD) is a morbid and potentially fatal condition characterized by excess glucocorticoid exposure secondary to an adrenocorticotropic hormone (ACTH)–secreting pituitary mass. Although several groups have reported high rates of surgical cure, in the real world, identifying ideal surgical candidates and distinguishing them from other causes of hypercortisolism represents a major diagnostic challenge. Misdiagnosis can lead to higher failure rates than previously reported. We set out to determine the actuarial cure rates for patients presenting with a constellation of symptoms suggestive of pituitary dependent Cushing’s syndrome who underwent surgical intervention, regardless of their ultimate diagnosis. We also performed a root cause analysis (RCA) of our treatment failures.