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Negative correlation between tumour size and cortisol/ACTH ratios in patients with Cushing’s disease harbouring microadenomas or macroadenomas

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Abstract

Purpose

Pituitary macroadenomas (MACs) represent 10–30 % of Cushing’s disease (CD) cases. The aim of this study was to report the clinical, laboratorial and imaging features and postsurgical outcomes of microadenoma (MIC) and MAC patients.

Methods

Retrospective study with 317 CD patients (median 32 years old, range 9–71 years) admitted between 1990 and 2014, 74 (23.3 %) of whom had MAC.

Results

Hirsutism, plethora facial, muscular weakness and muscular atrophy were more frequent in the MIC patients. Nephrolithiasis, osteopenia, hyperprolactinaemia and galactorrhoea were more prevalent in MAC patients. The morning serum cortisol (Fs), nocturnal salivary cortisol (NSC), nocturnal Fs (Fs 2400 h), low- and high-dose dexamethasone suppression test results and CRH and desmopressin test results were similar between the subgroups. MIC patients showed higher urinary cortisol at 24 h (UC), and MAC patients presented higher ACTH levels but lower Fs/ACTH, Fs 2400 h/ACTH, NSC/ACTH and UC/ACTH ratios. There were negative correlations of tumour size with Fs/ACTH, Fs 2400 h/ACTH, NSC/ACTH and UC/ACTH ratios. Overall, the postsurgical remission and recurrence rates were similar between MIC and MAC. However, patients in remission (MIC + MAC) showed smaller tumour diameters and a lower prevalence of invasion and extension on MRI.

Conclusions

Despite exhibiting higher plasma ACTH levels, CD patients with MAC presented lower cortisol/ACTH ratios than did patients with MIC, with a negative correlation between tumour size and cortisol/ACTH ratios. The overall postsurgical remission and recurrence rates were similar between MIC and MAC patients, with those with larger and/or invasive tumours showing a lower remission rate.

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Acknowledgments

We want to thank Dr. Vinicius Nahime de Brito for the statistical analysis of the clinical parameters.

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Authors and Affiliations

  1. Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of Sao Paulo Medical School, São Paulo, SP, Brazil

    M. C. Machado, A. E. E. Alcantara, A. C. L. Pereira, M. D. Bronstein & M. C. B. V. Fragoso

  2. Laboratory of Cellular and Molecular Endocrinology LIM-25, University of Sao Paulo Medical School, São Paulo, SP, Brazil

    M. C. Machado & M. D. Bronstein

  3. Division of Neurosurgery, University of Sao Paulo Medical School, São Paulo, SP, Brazil

    V. A. S. Cescato & N. R. Castro Musolino

  4. Laboratório de Hormônios e Genética Molecular LIM-42, University of Sao Paulo Medical School, São Paulo, SP, Brazil

    B. B. de Mendonça & M. C. B. V. Fragoso

  5. Endocrinology Division, AC Camargo Cancer Center, São Paulo, SP, Brazil

    M. C. Machado

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  1. M. C. Machado
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  2. A. E. E. Alcantara
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  3. A. C. L. Pereira
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  4. V. A. S. Cescato
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  8. M. C. B. V. Fragoso
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Correspondence to M. C. Machado.

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The authors declare that they have no conflicts of interest.

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All of the 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.

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For this study, formal consent was not required.

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Machado, M.C., Alcantara, A.E.E., Pereira, A.C.L. et al. Negative correlation between tumour size and cortisol/ACTH ratios in patients with Cushing’s disease harbouring microadenomas or macroadenomas. J Endocrinol Invest 39, 1401–1409 (2016). https://doi.org/10.1007/s40618-016-0504-y

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  • DOI: https://doi.org/10.1007/s40618-016-0504-y

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