Negative correlation between tumour size and cortisol/ACTH ratios in patients with Cushing’s disease harbouring microadenomas or macroadenomas

Purpose Pituitary macroadenomas (MACs) represent 10–30 % of Cushing’s disease (CD) cases. The aim of this study was to report the clinical, laboratorial and imaging features and postsurgical outcomes of microadenoma (MIC) and MAC patients. Methods Retrospective study with 317 CD patients (median 32 ...

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Published in:	Journal of endocrinological investigation Vol. 39; no. 12; pp. 1401 - 1409
Main Authors:	Machado, M. C., Alcantara, A. E. E., Pereira, A. C. L., Cescato, V. A. S., Castro Musolino, N. R., de Mendonça, B. B., Bronstein, M. D., Fragoso, M. C. B. V.
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-12-2016 Springer Nature B.V
Subjects:	Adenoma - blood Adenoma - etiology Adenoma - pathology Adolescent Adrenal glands Adrenocorticotropic hormone Adrenocorticotropic Hormone - blood Adult Aged Atrophy Child Cortisol Cushing's disease Desmopressin Dexamethasone Endocrinology Enzyme-Linked Immunosorbent Assay Female Hirsutism Hormones Humans Hydrocortisone - blood Magnetic Resonance Imaging Male Medicine Medicine & Public Health Metabolic Diseases Middle Aged Neoplasm Recurrence, Local Nephrolithiasis Nervous system diseases Original Article Osteopenia Pituitary Pituitary ACTH Hypersecretion - complications Pituitary ACTH Hypersecretion - physiopathology Pituitary Neoplasms - blood Pituitary Neoplasms - etiology Pituitary Neoplasms - pathology Remission Retrospective Studies Tumors Young Adult Microadenoma Pituitary surgery Cushing’s disease Macroadenoma
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Summary:	Purpose Pituitary macroadenomas (MACs) represent 10–30 % of Cushing’s disease (CD) cases. The aim of this study was to report the clinical, laboratorial and imaging features and postsurgical outcomes of microadenoma (MIC) and MAC patients. Methods Retrospective study with 317 CD patients (median 32 years old, range 9–71 years) admitted between 1990 and 2014, 74 (23.3 %) of whom had MAC. Results Hirsutism, plethora facial, muscular weakness and muscular atrophy were more frequent in the MIC patients. Nephrolithiasis, osteopenia, hyperprolactinaemia and galactorrhoea were more prevalent in MAC patients. The morning serum cortisol (Fs), nocturnal salivary cortisol (NSC), nocturnal Fs (Fs 2400 h), low- and high-dose dexamethasone suppression test results and CRH and desmopressin test results were similar between the subgroups. MIC patients showed higher urinary cortisol at 24 h (UC), and MAC patients presented higher ACTH levels but lower Fs/ACTH, Fs 2400 h/ACTH, NSC/ACTH and UC/ACTH ratios. There were negative correlations of tumour size with Fs/ACTH, Fs 2400 h/ACTH, NSC/ACTH and UC/ACTH ratios. Overall, the postsurgical remission and recurrence rates were similar between MIC and MAC. However, patients in remission (MIC + MAC) showed smaller tumour diameters and a lower prevalence of invasion and extension on MRI. Conclusions Despite exhibiting higher plasma ACTH levels, CD patients with MAC presented lower cortisol/ACTH ratios than did patients with MIC, with a negative correlation between tumour size and cortisol/ACTH ratios. The overall postsurgical remission and recurrence rates were similar between MIC and MAC patients, with those with larger and/or invasive tumours showing a lower remission rate.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1720-8386 0391-4097 1720-8386
DOI:	10.1007/s40618-016-0504-y