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- Title
Cushing macroadenoma: A single centre experience.
- Authors
Kakade, Harshal Ramesh; Kasliwal, Rajeev; Budyal, Sweta; Khare, Shruti; Lila, Anurag; Bandgar, Tushar; Shah, Nalini
- Abstract
Introduction: Cushing syndrome due to pituitary macroadenoma is less common compared to microadenoma. Behavior of the tumor in terms of clinical profile and response to various modalities of treatment is different from microadenoma. We share our 20 years of experience of Cushing macroadenoma with the clinical profile and treatment outcome. Aim and Objective: To study clinical profile and treatment outcome of a patient of Cushing disease with macroadenoma to a single tertiary care center in India. Patients and Methods: Medical record of 40 patients diagnosed with Cushing syndrome with macroadenoma from the year 1993-2012 were reviewed and analyzed. Results: Out of 40 patients, 16 (40%) were male and 24 (60%) were female. Mean age of presentation was 27.6 ± 10.67 years. Median duration between the onset of symptoms and diagnosis was 24 months. Median adrenocorticotrophic hormone (ACTH) value was 97.1 pg/ml. 50% or more supressibility for low dose dexamethasone suppression (LDDS) was found in 10/38 patients. Visual field defects and mass effects were found in 15 patients. Mean maximum dimension of tumor was 20.7 ± 9.8 mm. All 40 patients underwent TSS. Five patients underwent early remission defined as day 5 cortisol <1.8 μg/dl (though five patients showed relapse) and 10 patients showed delayed remission defined as 6-12 weeks LDDS <1.8 μg/d (no relapses). Between 25 uncured patients and two relapses, nine lost follow-up. Among two relapsed patients, one patient underwent 2nd TSS, remined uncured and cured by radiotherapy and the second patient is on medical management. Between 18 uncured patients, two expired and two preferred medical management. Fourteen patients underwent definitive management in the form of TSS or radiotherapy, 2nd TSS was done in four patients, and three patients who remained uncured were subjected to RT and got cured. Ten patients underwent radiotherapy as 2nd line of treatment of which six patients were cured, two remained uncured and two patients lost follow-up. Between two uncured patients after radiotherapy, one patient managed with medical therapy and the other underwent 2nd and 3rd TSS, still uncured and on medical management. Conclusion: Out of 40, 15 (37.5%) patients were cured after 1st TSS. 2nd TSS was done in six patients, but only 1 (17.5%) got cured. Radiotherapy was done in 14 patients, out of which 10 (71.5%) were cured, proving as effective modality of treatment for Cushing macroadenomas.
- Subjects
INDIA; CUSHING'S syndrome; PITUITARY tumors; ADRENOCORTICOTROPIC hormone; DISEASE remission; CANCER relapse; CANCER radiotherapy
- Publication
Indian Journal of Endocrinology & Metabolism, 2012, Vol 16, pS517
- ISSN
2230-8210
- Publication type
Article