Corticotroph tumor progression speed after adrenalectomy

in European Journal of Endocrinology
Authors:
Laura BessièneDepartment of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique–Hôpitaux de Paris, Paris, France

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Sandrine MoutelDepartment of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique–Hôpitaux de Paris, Paris, France

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Marine LataudDepartment of Radiology, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France

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Anne JouinotDepartment of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Fidéline Bonnet-SerranoDepartment of Hormonology, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Jean GuibourdencheDepartment of Hormonology, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France

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Chiara VillaDepartment of Pathological Cytology and Anatomy, Hôpital Pitié Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Bertrand BaussartDepartment of Neurosurgery, Hôpital Pitié Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Stephan GaillardDepartment of Neurosurgery, Hôpital Pitié Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Maxime BaratDepartment of Radiology, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Anthony DohanDepartment of Radiology, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Xavier BertagnaDepartment of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Bertrand DoussetDepartment of Visceral and Endocrine Surgery, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Jérôme BertheratDepartment of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Guillaume AssiéDepartment of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique–Hôpitaux de Paris, Paris, France
Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France

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Correspondence should be addressed to G Assié; Email: guillaume.assie@aphp.fr
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Objectives

After bilateral adrenalectomy in Cushing’s disease, corticotroph tumor progression occurs in one-third to half of patients. However, progression speed is variable, ranging from slow to rapid. The aim was to explore corticotroph progression speed, its consequences and its risk factors.

Design

A retrospective single-center observational study.

Methods

In total,103 patients with Cushing’s disease who underwent bilateral adrenalectomy between 1990 and 2020 were included. Clinical, biological, histological and MRI features were collected. Median duration of follow-up after bilateral adrenalectomy was 9.31 years.

Results

In total,44 patients progressed (43%). Corticotroph tumor progression speed ranged from 1 to 40.7 mm per year. Progression speed was not different before and after bilateral adrenalectomy (P  = 0.29). In univariate analyses, predictive factors for rapid corticotroph tumor progression included the severity of Cushing’s disease before adrenalectomy as the cause of adrenalectomy, high ACTH in the year following adrenalectomy and high Ki67 immunopositivity in the tumor. During follow-up, early morning ACTH absolute variation was associated with corticotroph tumor progression speed (P-value = 0.001). ACTH measurement after dynamic testing did not improve this association.

Conclusion

After adrenalectomy, corticotroph progression speed is highly variable and manageable with MRI and ACTH surveillance. Progression speed does not seem related to bilateral adrenalectomy but rather to intrinsic properties of highly proliferative and secreting tumors.

 

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