ACTH-secreting macroadenoma: Experience from a single tertiary care center in India

Kakade, Harshal
September 2013
Indian Journal of Endocrinology & Metabolism;2013 Supplement, Vol. 17 Issue S1, pS394
Academic Journal
Objective: To study clinical profile and treatment outcome of patient of Cushing disease with macroadenoma to a single tertiary care center in India. Patients and Methods: Medical records of 42 patients diagnosed with Cushing macroadenoma from 1993 to 2012 were reviewed. Results: Out of 42 patients, 16 were male and 24 were female. Mean age of presentation was 27.6 ± 10.67 years. Median duration between onset of symptoms and diagnosis was 24 months. Median ACTH value was 97.1 pg/mL. Visual field defects and mass effect were found in 15 patients. Mean maximum dimension of tumor was 20.7 ± 9.8 mm. All 42 patients underwent TSS . Six patients underwent early remission and eleven patients showed (first TSS: cure rate: 37%) delayed remission. Among 25 uncured patients and 4 relapses, 8 lost to follow-up and 2 died. Nineteen underwent second line of management-seven: second TSS, two: medical management and ten: radiotherapy. Cure rate of second TSS was 12.5% and radiotherapy was 71%. Conclusion: Largest series of Cushing macroadenoma. Compared to literature, we have large proportion of macroadenoma, young macros (<30 years: 60%), and larger tumor size. The peculiar feature is delayed cure 65% of cured patients. Results of second TSS were poor and radiotherapy is very effective mode of therapy.


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