A gender-dependent analysis of Cushing's disease in childhood: pre- and postoperative follow-up

ObjectiveTo analyse gender differences in the clinical presentation and recovery of paediatric patients with Cushing's disease (CD) after transsphenoidal surgery (TSS). Indeed, gender differences between paediatric patients with CD during presentation, after TSS and postoperative recovery have not been adequately studied. DesignData were obtained and retrospectively analysed from clinical reports and biochemical tests at the time of presentation, 5-9days after TSS and at the 6 and 12months postoperative follow-up visits to determine hypothalamic-pituitary-adrenal axis (HPAA) recovery. PatientsData from 102 paediatric patients (48 females, 54 males, mean age 12930) with CD who underwent TSS at the National Institute of Health (NIH) Clinical Center between 1997 and 2011. ResultsThere was equal distribution of paediatric CD between males and females (53% vs 47%; n=102, P=0484). Males were more likely than females to present with higher mean BMI Z-scores (22 +/- 07 vs 19 +/- 06, P=00079), lower mean height Z-scores (-12 +/- 13 vs -07 +/- 11, P=00467) and higher median plasma ACTH (122 vs 85 pmol/l; P=00495). Females did not present more frequently with any single sign or symptom. No significant differences were found between males and females for CD cure rates 5-9days after TSS (870% males vs 875% females, P=10), long-term cure rates (865% vs 937%; n=69; P=04374) and HPAA recovery time (112 +/- 25 vs 117 +/- 25months; n=47; P=01992). ConclusionsPaediatric CD is found to have equal distribution between males and females, but male patients present with elevated BMI and potentially shorter height and higher plasma ACTH. There is no significant difference in the cure rate or HPAA recovery time after TSS between males and females.