Long-Term Outcome of Trans-Sphenoidal Surgery for Cushing’s Disease in Indian Patients

Presentation Number: SAT 417
Date of Presentation: April 1st, 2017

Samir Hardevsingh Saini*1, Jaya Bhanu Kanwar1, Subhash B Yadav2, Shruti Gupta1, Sanjay Behari1 and Eesh Bhatia1
1Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, 2Sanjay Gandhi Postgraduate Institute of Medical Sciences

Abstract

Abstract: The results of trans-sphenoidal surgery (TSS) in Cushing’s disease (CD) vary widely depending upon patient characteristics as well as surgical experience. Patients in low-middle income countries such as India are often referred late for surgery which may affect outcome. We studied remission rates and endocrine deficiencies after TSS in patients with CD presenting to an academic centre in India. Sixty consecutive patients (45 females, median age 24.5 years) who underwent TSS between January 2000-2015 were studied. The median (range) duration of follow-up was 40 (3-138) months. Initial and long-term remission and relapse rates and pituitary hypofunction post-TSS were evaluated. Eighteen (30%) patients harboured macroadenomas. Twenty-eight (47%) patients achieved remission in the immediate post-operative period (8 AM serum cortisol <140 nmol/l). However, remission rate was higher at 6 months (72%). At 1 year 70% of patients and at final follow-up [median 40 (range 3–138) months], 58% of patients were in remission. No pre- or post-surgical variables were consistently associated with remission except for the immediate post-operative 8 AM serum cortisol. Seven (18%) patients relapsed during follow-up, including 5 patients who had serum cortisol <140 nmol/l immediately after surgery. Mortality occurred in 5 (8%) of patients, all with persistent disease or relapse. Twelve (25%) patients newly developed hypothyroidism and 1 (1.6%) patient developed amenorrhoea after TSS. Thus, remission rate at six months was higher than immediately after TSS. A significant proportion of patients relapsed, thus necessitating life-long follow-up. New-onset hypothyroidism was frequent after TSS.

 

Nothing to Disclose: SHS, JBK, SBY, SG, SB, EB