ESPE Abstracts

Objective: Transsphenoidal surgery (TSS) is a treatment of choice for Cushing`s disease (CD), whose effectiveness range is from 70 to 90%. Recurrence rate after successful treatment is about 25%. Preoperative predictors of remission and recurrence are still unexplored what leads to further investigations.

Aim: Analysis of remission and recurrence rates of CD after radical treatment according to preoperative MRI.

Design: We conducted a retrospective analysis of 91 pediatric patients with CD who underwent treatment between 1992 and 2020.

Methods: Patients were divided into 3 groups according to preoperative MRI results: 1 group – patients with no visible adenoma [n = 37], 2 group – patient with microadenoma (<10 mm) [n = 41], and 3 group of patients with macroadenoma (>10 mm) [n = 13]. 63 of 91 patients (69%) underwent TSS, and 28 patients – radiosurgery (31%). Efficacy of treatment was confirmed if the morning cortisol or 24-hour urinary-free cortisol (24-h UFC) values below normal range for the assay used. Recurrence of CD was defined as a manifestation of clinical symptoms consistent with CD with elevated 24-h UFC and lack of cortisol suppression during low-dose dexamethasone suppression test after confirmed remission of CD.

Results: 19 of 37 patients from the 1 group underwent TSS (51%), remission rate was 63% [12/19]; 18 patients underwent radiosurgery (49%), remission rate was 83% [15/18]. In the 2 group 32 of 41 patients underwent TSS (78%), remission rate of 72% was achieved [23/32]; 9 patients underwent radiosurgery (22%), remission rate was 78% [7/9]. In the 3 group 12 of 13 patients underwent TSS (92%), remission rate was 83% [10/12]; 1 patient underwent radiosurgery (8%), remission was achieved. If 1^st line of treatment was unsuccessful [23/91], another therapeutic option (radiosurgery after TSS and vice-versa) or the same therapy repeatedly was performed [21\23], remission was achieved in 81% of patients [17\21], 6 patients were lost to follow-up. Recurrence rate after 1^st successful treatment was 12% [8/68]: 1 of 27 patients from 1 group [4%], 4 of 30 patients from 2 group [13%], 3 of 11 from 3 group [27%]. Recurrence rate after few treatment options was 18% [3/17]: 1 of 5 patients from 1 group [20%] and 2 of 10 patients from 2 group [20%]. There were no significant differences in recurrence rates after successful treatment between groups (P = 0.054) (х² analysis).

Conclusions: Our study didn’t show any differences in remission and recurrence rate after successful treatment according to preoperative MRI.