Hypopituitarism in Cushing's disease.

Area of Science:

• Endocrinology
• Neuroendocrinology
• Metabolic Disorders

Background:

• Cushing's syndrome is frequently associated with impaired growth hormone (GH) secretion.
• Recovery of normal GH secretion post-treatment for Cushing's disease is variable.
• Surgical remission of hypercortisolism is the primary treatment for ACTH-secreting adenomas.

Purpose of the Study:

• To prospectively evaluate GH secretion in patients with Cushing's disease in long-term remission after surgery.
• To determine the prevalence of GH deficiency (GHD) in surgically treated Cushing's disease patients.
• To assess the impact of surgical remission on GH secretion recovery.

Main Methods:

• Prospective study of 34 patients (27 female, 7 male) with a history of Cushing's disease.
• Patients achieved remission via transsphenoidal surgery for ACTH-secreting adenomas.
• GH response was assessed using GHRH+arginine stimulation tests 2-20 years post-surgery.

Main Results:

• 65% of patients (22/34) in long-term surgical remission exhibited subnormal GH secretion.
• Partial GHD was identified in 11 patients, and severe GHD in another 11 patients.
• No patients had undergone radiation therapy.

Conclusions:

• A high percentage of patients with Cushing's disease demonstrate impaired GH secretion even after successful surgical remission.
• Surgical treatment, while effective for hypercortisolism, often results in persistent GH deficiency.
• Routine assessment of GH secretion is recommended for all patients cured of Cushing's disease, irrespective of prior radiotherapy.