Late Recurrences of Cushing’s Disease after Initial Successful Transsphenoidal Surgery

Patil, Chirag G.; Prevedello, Daniel M.; Lad, Shivanand P.; Vance, Mary Lee; Thorner, Michael O.; Katznelson, Laurence; Laws, Edward R.

doi:10.1210/jc.2007-2013

Cited by 289 publications

(220 citation statements)

References 29 publications

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“…As previously reported, remission rates were higher in patients with microadenomas vs macroadenomas and recurrence outcomes were worse in patients with macroadenomas compared with microadenomas (6). Interestingly, duration of follow-up had no influence on recurrence rates in our analysis, while it has been previously reported that the risk for recurrence increased with long-term follow-up (51). This suggests that certain types of tumor may be more aggressive than others and may recur early during the follow-up period.…”

Section: Discussioncontrasting

confidence: 56%

THERAPY OF ENDOCRINE DISEASE: Outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence

Petersenn¹,

Beckers²,

Ferone³

et al. 2015

European Journal of Endocrinology

132

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Objective: A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's diseaseincluding different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence. Methods: We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed. Results: Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience.

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Section: Discussioncontrasting

confidence: 56%

THERAPY OF ENDOCRINE DISEASE: Outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence

Petersenn¹,

Beckers²,

Ferone³

et al. 2015

European Journal of Endocrinology

132

View full text Add to dashboard Cite

show abstract

“…In patients with Cushing disease (CD), the most common form of endogenous CS, surgical success rates are variable, ranging from 65 to 90% when performed by an experienced surgeon (6,7). Among those patients with successful outcomes following transsphenoidal surgery, 11 to 66% will go on to develop recurrence of hypercortisolism with long-term follow-up (6,(8)(9)(10)(11)(12). Therefore, additional medical interventions are often required to achieve remission or improve the clinical manifestations of CS.…”

Section: Introductionmentioning

confidence: 99%

Association Between Mifepristone Dose, Efficacy, and Tolerability in Patients With Cushing Syndrome

Yuen

Williams

Kushner³

et al. 2015

Endocrine Practice

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“…In the present study, plasma cortisol levels considered were < 1.8 μg/dL during the first days after surgery for cure definition -this is a very strict criterion. Notably, the criteria for cure vary significantly in the studies from the last 25 years, justifying the variable surgical cure rates observed (29,30). In addition, the experience of the neurosurgeon is another important factor.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center

Oliveira

Castro²,

Antonini³

et al. 2010

Arq Bras Endocrinol Metab

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Objective: The aim of this study was to review the results of surgery for pediatric patients with Cushing's disease who were less than 18 years old and underwent transsphenoidal surgery in a specialized center during a 25-year period. Subjects and methods: Retrospective study, in which the medical records, histology and pituitary imaging of 15 consecutive pediatric patients with Cushing's disease (mean age: 13 years) were evaluated by the same team of endocrinologists and a neurosurgeon from 1982 to 2006. Patients were considered cured when there was clinical adrenal insufficiency and serum cortisol levels were below 1.8 μg/dL or 50 nmol/L after one, two, three, or seven days following surgery; they therefore required cortisone replacement therapy. Follow-up was for a median time of 11.5 years (range: 2 to 25 years). Results: Clinical and biochemical cure was achieved in 9/15 patients (60%) exclusively after transsphenoidal surgery. Hypopituitarism was observed in four patients; growth hormone deficiency, in two; permanent diabetes insipidus, in one case. Conclusions: Cushing's disease is rare in children and adolescents. Transsphenoidal surgery is an effective and safe treatment in most of these patients. Plasma cortisol level < 1.8 μg/dL following surgery is the treatment goal and is a good predictive factor for long-term cure of Cushing's disease. Arq Bras Endocrinol Metab. 2010;54(1):17-23 Keywords Cushing's disease; pituitary tumor; transsphenoidal surgery; pediatric neurosurgery resumo Objetivo: O objetivo deste estudo foi avaliar os resultados cirúrgicos em pacientes pediátricos com doença de Cushing com idade inferior a 18 anos, submetidos à cirurgia transfenoidal num centro especializado, durante um período de acompanhamento de 25 anos. Sujeitos e métodos: Estudo retrospectivo dos prontuários médicos de 15 pacientes pediátricos com doença de Cushing (idade média de 13 anos), sendo avaliados aspectos clínicos, laboratoriais, histológicos e radiológicos. Todos os pacientes foram avaliados pela mesma equipe de endocrinologistas e operados por um mesmo neurocirurgião, entre 1982 e 2006. O tempo médio de seguimento foi 11,5 anos (2 a 25 anos). Os pacientes foram considerados curados quando houve insuficiência adrenal e níveis de cortisol plasmático inferiores a 1,8 μg/dL ou 50 nmol/L no pós-operatório um, dois, três ou sete dias após a cirurgia; estes pacientes necessitaram de reposição de corticosteroide. Resultados: Cura clínica e bioquímica foi alcançada em 9/15 pacientes (60%) após a cirurgia transfenoidal. Hipopituitarismo foi observado em quatro pacientes; déficit de hormônio de crescimento, em dois; diabetes insípido permanente, em um. Conclusões: A doença de Cushing é rara na infância e na adolescência. A cirurgia transfenoidal é um tratamento efetivo e seguro para a maioria dos pacientes. Uma concentração de cortisol plasmático < 1,8 μg/dL nos primeiros dias pós-cirurgia transfenoidal é o objetivo do tratamento e um fator preditivo tardio para a cura da doença de Cushing. Arq Bras Endocrinol...

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Late Recurrences of Cushing’s Disease after Initial Successful Transsphenoidal Surgery

Abstract: A quarter of the patients with Cushing's disease who achieve surgical remission after transsphenoidal surgery, recur with long-term follow-up. This finding emphasizes the need for continued biochemical and clinical follow-up to ensure remission after surgery.

Cited by 289 publications

References 29 publications

THERAPY OF ENDOCRINE DISEASE: Outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence

THERAPY OF ENDOCRINE DISEASE: Outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence

Association Between Mifepristone Dose, Efficacy, and Tolerability in Patients With Cushing Syndrome

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center

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