MON-100 Recurrent Cushing Disease Presenting with Obesity Unresponsive to Surgical and Medical Interventions - A Case Series

Abstract Disclosure: S.S. Mohammed: None. T. Mishra: None. M. Garcia-Touza: None. V.B. Patel: None. Recurrent Cushing Disease Presenting with Obesity Unresponsive to Surgical and Medical Interventions – A Case SeriesIntroduction: Cushing Disease (CD) is associated with increased morbidity and mortality. Recurrence after initial successful transsphenoidal surgery (TSS) is common. It is crucial to prioritize the diagnosis and management of recurrent CD before pursuing more intensive therapies targeting comorbidities like obesity and diabetes mellitus (DM). We present two patients with a history of successful initial TSS for CD, who failed surgical and medical treatments for obesity, respectively, before the recurrence of CD was confirmed. Case 1: 68-year-old female with a history of CD, successfully treated with TS, presented 10 years later with Class II obesity, Body Mass Index (BMI) 37 and uncontrolled diabetes mellitus. Despite Roux-en-Y gastric bypass three years prior, there was no significant weight loss. Her DM was uncontrolled with hemoglobin A1c persistently > 8%. Endocrine evaluation confirmed Recurrent CD clinically and biochemically. She underwent a second TSS for a sub centimeter pituitary adenoma. Three years after the second TSS, she has lost 37.5 kg, BMI 22.3, and A1c is now in the prediabetic range. Case 2: 35-year-old male underwent successful TSS for management of CD. Six years later, he presented with rapid weight gain and class III Obesity with BMI 55. He was treated by primary care with weight loss medication: GLP1 agonist therapy, for a year without success. Endocrine evaluation confirmed recurrent CD. He underwent a second TSS. Weight is now stable with expected improvement over time. Discussion: Recurrence of CD (rates ∼ 66%) poses a substantial challenge, after successful TSS. If left untreated, recurrence hinders the effectiveness of therapies directed at managing comorbidities. Bariatric surgery and weight loss medications are increasingly utilized with various medical specialties contributing to the multidisciplinary approach of obesity treatment. Gastric bypass and other weight loss surgeries can lead to complications like nutrient malabsorption, dumping syndrome, and anastomotic leaks, which are exacerbated in CD patients due to potential wound healing problems and immunosuppression related to hypercortisolemia. Weight loss medications despite their efficacy require close monitoring due to their potential adverse effects. Therefore, recurrent CD must be addressed promptly before embarking on intensive treatments. Conclusion: Heightened awareness along with timely diagnosis and management of recurrent CD is key to optimizing patient outcomes, avoiding risks associated with therapies such as bariatric surgery and weight loss medications as well as reducing the morbidity and mortality associated with CD. Presentation: Monday, July 14, 2025