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. 2016 Dec;19(6):612-624.
doi: 10.1007/s11102-016-0756-8.

Long-term outcomes of children treated for Cushing's disease: a single center experience

Galina Yordanova  1 , Lee Martin  2 , Farhad Afshar  3 , Ian Sabin  3 , Ghassan Alusi  4 , Nicholas P Plowman  5 , Fiona Riddoch  6 , Jane Evanson  7 , Matthew Matson  7 , Ashley B Grossman  2   8 , Scott A Akker  9 , John P Monson  9 , William M Drake  9 , Martin O Savage  9 , Helen L Storr  10
Affiliations

Long-term outcomes of children treated for Cushing's disease: a single center experience

Galina Yordanova et al. Pituitary. 2016 Dec.

Abstract

Purpose: Pediatric Cushing's disease (CD) is rare and there are limited data on the long-term outcomes. We assessed CD recurrence, body composition, pituitary function and psychiatric comorbidity in a cohort of pediatric CD patients.

Methods: Retrospective review of 21 CD patients, mean age at diagnosis 12.1 years (5.7-17.8), managed in our center between 1986 and 2010. Mean follow-up from definitive treatment was 10.6 years (2.9-27.2).

Results: Fifteen patients were in remission following transsphenoidal surgery (TSS) and 5 were in remission following TSS + external pituitary radiotherapy (RT). One patient underwent bilateral adrenalectomy (BA). CD recurrence occurred in 3 (14.3 %) patients: 2 at 2 and 6 years after TSS and 1 7.6 years post-RT. The BA patient developed Nelson's syndrome requiring pituitary RT 0.6 years post-surgery. Short-term growth hormone deficiency (GHD) was present in 14 patients (81 % patients tested) (11 following TSS and 3 after RT) and 4 (44 % of tested) had long-term GHD. Gonadotropin deficiency caused impaired pubertal development in 9 patients (43 %), 4 requiring sex steroid replacement post-puberty. Four patients (19 %) had more than one pituitary hormone deficiency, 3 after TSS and 1 post-RT. Five patients (24 %) had long-term psychiatric co-morbidities (cognitive dysfunction or mood disturbance). There were significant long-term improvements in growth, weight and bone density but not complete reversal to normal in all patients.

Conclusions: The long-term consequences of the diagnosis and treatment of CD in children is broadly similar to that seen in adults, with recurrence of CD after successful treatment uncommon but still seen. Pituitary hormone deficiencies occurred in the majority of patients after remission, and assessment and appropriate treatment of GHD is essential. However, while many parameters improve, some children may still have mild but persistent defects.

Keywords: Cushing’s disease; Outcome; Pediatric; Recurrence.

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Conflict of interest statement

The authors declare no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Height SDS at diagnosis, latest assessment and target height SDS (n = 15). Boxplot graph of the 15 patients with follow-up and target height growth data. Box, interquartile range (lower quartile, median and upper quartile); whiskers, maximum and minimum values; outliers represented with circle and patient number. *p = 0.033, **p = 0.000
Fig. 2
Fig. 2
BMI SDS at diagnosis and follow-up (n = 15) Boxplot graph of the 15 patients with follow-up BMI data: box, interquartile range (lower quartile, median and upper quartile); whiskers, maximum and minimum values; outliers represented with circle and patient number. *p = 0.000
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