Assessment of the outcomes of the treatment of Cushing's disease in the hospitals of Castilla-La Mancha

Objective: Treatment of Cushing's disease poses interesting dilemmas in clinical practice. The aim of our study was to analyze the outcomes of the different treatments, the control and recurrence rates, and the complications derived from them. Material and methods: Data were collected from the clinical records of 22 patients over 18 years of age (86.4% women). They had been diagnosed with Cushing's disease between 2000 and 2012, and were monitored at Complejo Hospitalario Universitario-Albacete, Hospital Virgen de la Salud-Toledo Hospital General Universitario de Ciudad Real, Hospital Virgen de la Luz-Cuenca, Hospital Nuestra Senora del Prado-Talavera de la Reina, and Complejo Hospitalario la Mancha Centro-Alcazar de San Juan. Results: Surgery was the treatment of choice in all patients. Biochemical cure was achieved in 72.2% of patients. Nine patients developed in the early postoperative period diabetes insipidus, which became in two patients only. Surprisingly, three patients with normal postoperative neurohypophyseal function later developed permanent diabetes insipidus. New hormone deficiencies occurred in seven patients. Seventeen patients received ketoconazole before surgery (five of them after surgery also), and 70% of them achieved normal urinary free cortisol levels. Three patients also received radiotherapy, and all of them were cured after a median follow-up of 85.5 months; they developed no tumors or other complications. Conclusions: Our study reports the outcomes of management of Cushing's disease in non reference centers for this disease, possibly giving a realistic picture of standard clinical practice for the condition in Spain. (c) 2014 SEEN. Published by Elsevier Espana, S.L.U. All rights reserved.