Faculty Collaboration Database

Transsphenoidal surgery for Cushing disease: experience with 136 patients. Neurosurgery 2012 Jan;70(1):70-80; discussion 80-1

Date

07/21/2011

Pubmed ID

21772221

Pubmed Central ID

PMC4051420

DOI

10.1227/NEU.0b013e31822dda2c

Scopus ID

2-s2.0-84856106361 (requires institutional sign-in at Scopus site)   91 Citations

Abstract

BACKGROUND: This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery.

OBJECTIVE: To evaluate factors influencing immediate postoperative results and long-term outcomes.

METHODS: Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency.

RESULTS: IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, <0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P < .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08).

CONCLUSION: In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.

Author List

Ciric I, Zhao JC, Du H, Findling JW, Molitch ME, Weiss RE, Refetoff S, Kerr WD, Meyer J

Author

James W. Findling MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenocorticotropic Hormone
Aged
Aged, 80 and over
Child
Corticotropin-Releasing Hormone
Female
Humans
Longitudinal Studies
Magnetic Resonance Imaging
Male
Microsurgery
Pituitary ACTH Hypersecretion
Pituitary Gland
Postoperative Complications
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome