SUN-LB074 Racial Distribution, Presentation and Outcome in Acromegaly and Cushing's Disease: A Tertiary Referral Center Study in 220 Patients

Background: Transsphenoidal surgery (TSS) is the primary therapy for acromegaly (ACM) and Cushing’s disease (CD) with superior outcomes at high-volume centers. According to the U.S. Central Brain Tumor Registry, African Americans (AA) have higher incidence of pituitary adenomas than non-Hispanic white (W) patients, but race-specific data in ACM and CD are not available. Our aims are to evaluate racial distribution, presentation, and long-term outcomes of adult patients who underwent TSS for these conditions at our pituitary center by a single dedicated neurosurgeon. Methods: We reviewed all cases of TSS operated between 1994-2016 and compared presentation and postoperative events (biochemical remission, recurrence, reoperation, radiation, and death) across racial demographic groups. For patients living in Metropolitan Atlanta, we used U.S. Census data to compare patient racial distribution to the demographics. Results The ACM group consisted of 112 patients (54 men and 58 women), of whom 87 were W and 13 AA. Age and gender were similar in AA and W. Main reasons for referral were physical changes (23% AA vs 44% W), headaches (38% AA vs 17% W), and pituitary incidentaloma (31% AA vs 14% W). AA had higher rates of diabetes (54% vs 16%, p 0.005) and hypertension (69% vs 42% p 0.08), lower mean IGF-1 levels (662±324 ng/ml vs 823±321 ng/ml, p 0.06), and lower median GH levels (8.6. vs 45 ng/ml p 0.002). Mean tumor diameter and cavernous sinus invasion were similar. Biochemical remission at 3 months (46% AA and 55% W) and event-free survival during follow-up (median 3.8 years) were similar in AA and W. Normal IGF-1 at last follow-up was achieved by 92% AA and 80%W after multimodality therapy. The CD group consisted of 108 patients (15 men and 93 women) of whom 70 were W and 24 AA. Age, gender, and prevalence of diabetes and hypertension were similar in AA and W. Mean urinary cortisol and ACTH levels were similar. Mean tumor diameter was similar but AA had more macroadenomas (33% AA vs 14% W). During follow-up (median 4.3 years), event-free survival was similar although AA had fewer recurrences (4.35% vs 22.0% W, p 0.06). Of the total 220 operated patients, 88% lived in Georgia and 59% in Metropolitan Atlanta. In the latter group, W represented 75% of ACM and 62% of CD patients; AA 16% ACM and 28% CD; Hispanics (H) 0% ACM and 6.5% CD; Asian 8.2% ACM and 3% CD. Census racial distribution during study period was 58-67% W, 33-34% AA, 7-10% H, and 3-5% Asians. Conclusions To our knowledge, this is the first report of race-specific patient characteristics in CD and ACM. Proportion of AA and H with ACM operated at our tertiary referral center was lower than expected, while such disparity was not seen in CD. In addition AA with ACM exhibited different clinical presentations and milder biochemical activity. Notably, the long-term outcomes of patients with ACM and CD treated at our center were similar in AA and W. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.