Polycystic ovary syndrome (PCOS) and Cushing's syndrome (CS) a clinical conundrum

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-99
Jessica Allison Brzana*1, Christine G Yedinak1, Nadia Hameed1, Adeline Plesiu1, Shirley McCartney1 and Maria Fleseriu2
1Oregon Health & Science University, Portland, OR, 2Northwest Pituitary Center, Oregon Health & Science University, Portland, OR
CONTEXT: At presentation, CS and PCOS share many features including abnormal menses (AM), weight gain, metabolic dysfunction, hirsutism, and acne. CS pts often have significant morbidity worsened by diagnosis delay. While recognizing that PCOS prevalence is higher, the importance of screening those pts with CS features is emphasized.
METHODS: Retrospective review of 50 pts (38 F) with a proven pathology of Cushing’s disease (CD) at a single institution (2006 to 2011). We compared clinical features and duration of CS symptoms including AM and infertility before/after CD surgery for all F pts ≤ 50 yrs (26 pts) initially misdiagnosed with PCOS (grp 1:13 pts) vs pts suspected of having CS (grp 2:13 pts). Biochemical screening for CS included: UFC, late-night salivary cortisol and dexamethasone suppression test (DST).
RESULTS: For all 26 pts: mean age 36.9±8.3 yrs; BMI 35.6±7.3 (84.6% BMI >30); follow-up 17.6±15 mo; 25% macroadenomas. Screening tests were highly correlated, the highest between UFC and DST, rs=0.883, p≥0.000. 87% of pts had AM (mean duration 29.8±39.5 mo); AM normalized in 69.2% after surgery suggesting CS as causal at presentation; 96.2% weight gain; 84.6% hirsutism; 69.2% acne; and 46.2% alopecia. Using ANOVA only hirsutism p=0.030 and AM p=0.021 were significantly higher in grp 1 vs grp 2. 7 pts in each grp (p=0.203) had return of normal menses or fertility after CD remission despite a mean weight loss of only 5.9±6.9 kg. There was no difference in testosterone or DHEAs in 14 pts. Two pts with persistent AM (grp 1) had recurrent CD.
DISCUSSION: Obesity, insulin resistance, AM, and clinical or biochemical hyperandrogenism are all common features in women with both PCOS and CS. While diagnosis of PCOS is more common, screening for hypercortisolism should be considered in PCOS pts to avoid overlooking CS/CD. Overall, 50% of pts were misdiagnosed/treated initially with contraceptives, spironolactone and metformin for PCOS alone before a diagnosis of CD was made. Screening tests were highly concordant for CS in our pts. Clinical features at presentation did not differ between the 2 grps, except hirsutism and acne.
CONCLUSION: Further research is needed to determine which patients should be screened for CS. A cost-effectiveness analysis (delayed diagnosis of CS vs increased unnecessary diagnostic tests) would be valuable, in addition to performing studies with larger numbers of subjects and more specific standardized tests.

Nothing to Disclose: JAB, CGY, NH, AP, SM, MF

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