• Chun-Heng Kuo, Shyang-Rong Shih, Hung-Yuan Li, Szu-Chi Chen, Po-Ju Hung, Fen-Yu Tseng, and Tien-Chun Chang.
• Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; New Taipei City Hospital, New Taipei City, Taiwan.
• J Formos Med Assoc. 2017 Jun 1; 116 (6): 441-447.

Background/PurposeCushing's disease (CD) is the most common cause of endogenous Cushing's syndrome. Transsphenoidal surgery (TSS) is the first choice of treatment. Predicting prognosis after treatment can benefit further strategies of management, but currently there is no convenient predictor. This study aims to investigate characteristic changes after treatment and to identify potential prognostic predictors.MethodsWe retrospectively studied the records of CD patients presenting to the National Taiwan University Hospital, Taipei, Taiwan between 1992 and 2011. They were categorized according to treatment response. Clinical features and examination findings were compared between groups.ResultsForty-one patients with CD were included. The follow-up time was 0.26-19.3 years. The time interval between the onset of symptoms and diagnosis was 2.1-120.0 months. The initial remission rate of CD after the first treatment was 82.9%. Mean body mass index (BMI) was 27.4 kg/m2 before treatment and 26.0 kg/m2 3 months after treatment. The patients in remission had a greater decrease in BMI after treatment and lower dehydroepiandrosterone sulfate (DHEAS) levels before treatment, compared with the recurrent group (both p < 0.05). Adrenocorticotropic hormone (ACTH) levels before treatment showed a significant positive correlation with recurrent diseases (p < 0.05).ConclusionA larger decrease in BMI after treatment and lower DHEAS levels before treatment were noted for the patients who stayed in CD remission. Higher ACTH levels before treatment predicted a recurrence of CD. These are potentially simple and practical predictors of prognosis.Copyright © 2016. Published by Elsevier B.V.

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