Objective: The first line of treatment for Cushing`s disease (CD) is transsphenoidal surgery (TSS), whose effectiveness range is from 70 to 90%. If surgical treatment is unsuccessful or recurrence appears, radiation treatment (RT) is the next therapeutic option, which effectiveness range is also 90%, but the hypopituitarism rate as side effect of treatment is higher.
Aim: Analysis of recurrence rates of CD and side effects after successful treatment according to therapeutic option.
Design: We conducted a retrospective analysis of 90 pediatric patients with CD who underwent treatment between 1992 and 2020.
Methods: Patients were divided into 2 groups according to therapeutic option: 1 group - underwent TSS only [n=55], 2 group – underwent RT on one of the steps of treatment [n=35]. Patients who underwent TSS as 1st line of treatment and were tested in the early postoperative period [n=61] were also divided on 2 groups according to developed adrenal insufficiency: 1 group – patients who developed adrenal insufficiency [n=38], and 2 group - patients without [n=23].
Results: Recurrence rate after successful treatment was 11% [10/90]. In the group after TSS recurrence rate was 14% [8/55], in the group after RT – 6% [2/35]. Time to recurrence was statistically different after TSS compared to radiosurgery (mean time to recurrence after TSS was 3,3 years, after RT – 6 years; P=0.007, Kaplan–Meier analysis). In the group with developed adrenal insufficiency in the early postoperative period recurrence rate was 13% [5/38], in the group without – 14% [4/23]. Time to recurrence was statistically shorter in the group with developed adrenal insufficiency (mean time to recurrence in the 1st group was 2,65 years, after RT – 3,56 years; P=0.04, Kaplan–Meier analysis). The frequency of growth hormone deficiency after TSS was 49% [27/55] and after RT was 91% [32/35]; hypothyroidism was diagnosed in 45% after TSS [25/55] and in 60% [21/35] after RT; gonadotrophin deficiency - in 27% after TSS [13/55] and in 48% [17/35] after RT. Diabetes insipidus was diagnosed only after TSS. Analysis of side effect of treatment showed that the frequency of growth hormone and gonadotrophin deficiency was statistically higher after radiosurgery (р<0,01, Kruskel—Wallis ANOVA test).
Conclusions: Therapeutic option has an impact on time to recurrence, not on recurrence rates. Adrenal insufficiency in the early postoperative period couldn`t be used as a predictor of long-term remission. The frequency of growth hormone and gonadotrophin deficiency was statistically higher after radiosurgery compared to TSS.
15 Sep 2022 - 17 Sep 2022