Treatment of Cushing’s disease (CD) after primary failure of transsphenoidal surgery or recurrence: evaluation of long-term control by drug treatment
A. Ghalawinjia (Dr), J. Cristanteb (Dr), M. Mullerb (Dr), V. Lefournierc (Dr), P. Chaffanjond (Prof), N. Sturme (Prof), L. Drezetf (Mr), C. Pasterisg (Dr), E. Gayh (Prof), O. Chabre*a (Prof)
a CHU Grenoble Alpes, Grenoble, FRANCE ; b Endocrinologie CHU Grenoble Alpes, Grenoble, FRANCE ; c Neuroradiologie Clinique du Mail, Grenoble, FRANCE ; d Chirurgie Endocrine CHU Grenoble Alpes, Grenoble, FRANCE ; e Pathologie Cellulaire CHU Grenoble Alpes, Grenoble, FRANCE ; f École Polytechnique Universitaire de l'Institut polytechnique de Grenoble, Grenoble, FRANCE ; g Radiothérapie CHU Grenoble Alpes, Grenoble, FRANCE ; h Neurochirurgie CHU Grenoble Alpes, Grenoble, FRANCE
In case of failure of transsphenoidal surgery (TSS) or recurrence, the different second-line therapies used for treatment of Cushing’s disease (CD) include drug treatment (DT), 2nd transsphenoidal surgery (2ndTSS), bilateral adrenalectomy (BA), pituitary radiotherapy (PR). We aimed to evaluate the long-term control by DT.
Design and Methods
Monocentric retrospective study of 119 patients treated by PS for CD in 2001-2020, with 36 candidates for a second-line therapy, including 19 PS failures (surgical remission rate 84%) and 17 recurrences (recurrence rate 17%).
The 36 patients were treated either/or by DT: 29/36(80%); 2ndTSS: 16/36(50%); BA: 14/36(39%) and PR: 3/36(8%). In the 29 DT patients the drugs used were ketoconazole (27/29), metyrapone (15/29), cabergoline (11/29), osilodrostat (8/29), mitotane (3/29), pasireotide (3/29).
At the end of the study, control of CD was achieved by DT in 11 patients (30% of 36 patients, 34% of DT treated patients) 2nd TSS in 8 patients (22% of 36 patients, 50% of reoperated patients) and BA in 14 patients (39% of 36 patients, 100% of operated patients). The 11 patients controlled by DT were using either ketoconazole (6/27 exposed), metyrapone (1/15 exposed) or osilodrostat (6/8).
In patients with Cushing’s disease and either primary failure of transsphenoidal surgery or recurrence after a first transsphenoidal surgery, drug treatment allowed long-term control of 11/36 (30%) patients, who were all treated by adrenal cortisol synthesis inhibitors. Drug treatment also allowed to delay surgery in 13/16 patients treated by a 2nd transsphenoidal surgery and in 11/14 patients treated by bilateral adrenalectomy
The author has declared no conflict of interest.