Background and purpose: Diagnosis and management of Cushing's syndrome is a challenge to the endocrinologist. This retrospective study investigated the etiology, clinical presentation, treatment and prognosis of endogenous Cushing's syndrome and compared the differences of prognostic factors between Cushing's disease patients with macroadenoma and microadenoma.
Methods: Data on disease history, physical examination, and biochemistry of Cushing's syndrome and factors related to the prognosis of Cushing's disease were analyzed.
Results: A total of 61 consecutive patients (52 women and 9 men) with endogenous Cushing's syndrome treated from January 1992 to July 2002 were included in this study. They comprised 31 cases of adrenal adenoma, 19 cases of Cushing's disease, 6 cases of ectopic adrenocorticotropin (ACTH) syndrome, 3 cases of adrenal carcinoma, 1 case of macronodular hyperplasia, and 1 case of micronodular hyperplasia. ACTH-independent Cushing's syndrome was the most frequent etiology in this series. The most common symptoms and signs were moon face (89%), weight gain (74%), buffalo hump (74%), and truncal obesity (72%). Hypercholesterolemia was noted in 27 of 45 patients (60.0%) checked for total serum cholesterol level. Elevation of serum lactate dehydrogenase was found in 29 (74.3%) of 39 patients assessed. Patients with adrenal adenoma had the highest cure rate. High residual (2/17, 11.8%) and recurrent rates (5/17, 29.4%) were found in patients with Cushing's disease. There were no significant differences in prognostic factors between Cushing's disease patients with macroadenoma and microadenoma.
Conclusions: ACTH-independent Cushing's syndrome was the most frequent type of Cushing's syndrome in this series. The dyslipidemia and elevation of lactate dehydrogenase activity in this series indicated the need for routine laboratory testing in Cushing's syndrome patients. This study found no significant differences in prognostic factors between Cushing's disease patients with macroadenoma and microadenoma.