(CSEMP063) CUSHING'S DISEASE MANAGEMENT AT THE CHU DE QUÉBEC UNIVERSITÉ LAVAL : A RETROSPECTIVE COHORT STUDY

Abstract: Background : Cushing’s syndrome is a rare clinical entity characterized by a high secretion of endogenous cortisol. It is classified as Cushing’s Disease when it is caused by a pituitary adenoma. When untreated, the mortality rate is increased by 1,4-3,8 times. The first line of treatment is transsphenoidal surgery. Reported postoperative remission is between 65 to 98%. It varies according to neurosurgeon expertise, adenoma size and location, and remission criteria. Long term recurrence is also possible. When surgery is not curative, medical treatment is indicated. The objective of this study was to determine remission and control rates of Cushing’s Disease one year after initial treatment and at the last follow-up in a perspective of quality of care assessment.

Methods : This is a unicentric retrospective descriptive cohort study. Adults with Cushing’s Disease treated at the CHU de Québec – Université Laval between January 2000 and June 2022 and followed by the endocrinology service were included. Silent corticotropic adenomas were excluded. The remission status was defined by the endocrinologist after surgery or other permanent treatment. Patients on active corticosteroid replacement were considered in remission. When on medical treatment, disease’s control (either persistent endogenous hypercorticism or not) was assessed at each follow-up visit. The control status of medical comorbidities was also assessed.

Results : 75 records were screened and 40 patients were included. 57,5 % had a microadenoma, 40% had a macroadenoma and 2,5% had no visible tumor on MRI. 95% of patients underwent transphenoidal surgery, 25% had radiation therapy, 55% received pharmacological therapy and 15% underwent bilateral adrenalectomy. The median follow-up length was 79,5 months. The combined remission and disease control rate at one year of treatment was 87,5% and it was 92,5% at the last follow-up visit. Six patients (15%) died during the follow-up but only one of them was not in remission.

Conclusion : In our study, the combined remission and disease control rate after several years of follow-up at CHU de Québec-Université Laval was 92,5% using multiple treatment modalities for patients with Cushing’s Disease.