Long-Term Follow up of Trans-Sphenoidal Hypophysectomy for Cushing's Disease

Brand, I R; Dalton, G. A.; Fletcher, R. F.

doi:10.1177/014107688507800404

Cited by 19 publications

(9 citation statements)

References 6 publications

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“…The type of surgical operation performed did not appear to have a dramatic impact on the long-term remission rate. Indeed, total hypophysectomy is associated with a remission rate ranging from 0 to 100%, with mean and median remission rates of 75.3 and 75%, respectively (14,91,92,94,95,98,99,101,106,108,109,117,128,129,133,135,146,157,158,165,171), whereas the hemihypophysectomy is associated with a remission rate ranging from 33.3 to 100%, with mean and median rates of 71.7 and 75.6%, respectively (14,117,128,129,135,146,157,164,165,171). These data are not dramatically different from those associated with selective adenomectomy, which has a remission rate ranging from 59.3 to 100%, with mean and median remission rates of 81.6 and 80%, respectively (14, 93, 94, 98, 100, 102, 104, 106 -108, 115, 117, 118, 128, 129, 133, 135, 146, 157, 158, 160, 163, 164, 167-171, 210).…”

Section: Predictive Factors For the Outcome Of Pituitary Surgerymentioning

confidence: 99%

“…In seven series including only patients who underwent selective adenomectomy, no case of new pituitary deficiency was described (93,100,123,130,132,138,168), but in all series that included only patients who had undergone total hypophysectomy, hypopituitarism was always reported (91,92,99,101). Considering all the studies reporting the general rate of hypopituitarism, this rate ranges between 0.9 and 93.3% (mean, 29.6%; median, 17.6%) (14,18,91,107,117,126,128,133,134,137,139,154,157,160,163,166,170,171).…”

Section: Hypopituitarismmentioning

confidence: 99%

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The Treatment of Cushing's Disease

et al. 2015

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Cushing's disease (CD), or pituitary-dependent Cushing's syndrome, is a severe endocrine disease caused by a corticotroph pituitary tumor and associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 78% and relapse in around 13% of patients during the 10-year period after surgery, so that nearly one third of patients experience in the long-term a failure of surgery and require an additional second-line treatment. Patients with persistent or recurrent CD require additional treatments, including pituitary radiotherapy, adrenal surgery, and/or medical therapy. Pituitary radiotherapy is effective in controlling cortisol excess in a large percentage of patients, but it is associated with a considerable risk of hypopituitarism. Adrenal surgery is followed by a rapid and definitive control of cortisol excess in nearly all patients, but it induces adrenal insufficiency. Medical therapy has recently acquired a more important role compared to the past, due to the recent employment of novel compounds able to control cortisol secretion or action. Currently, medical therapy is used as a presurgical treatment, particularly for severe disease; or as postsurgical treatment, in cases of failure or incomplete surgical tumor resection; or as bridging therapy before, during, and after radiotherapy while waiting for disease control; or, in selected cases, as primary therapy, mainly when surgery is not an option. The adrenal-directed drug ketoconazole is the most commonly used drug, mainly because of its rapid action, whereas the glucocorticoid receptor antagonist, mifepristone, is highly effective in controlling clinical comorbidities, mainly glucose intolerance, thus being a useful treatment for CD when it is associated with diabetes mellitus. Pituitary-directed drugs have the advantage of acting at the site responsible for CD, the pituitary tumor. Among this group of drugs, the dopamine agonist cabergoline and the somatostatin analog pasireotide result in disease remission in a consistent subgroup of patients with CD. Recently, pasireotide has been approved for the treatment of CD when surgery has failed or when surgery is not an option, and mifepristone has been approved for the treatment of Cushing's syndrome when associated with impairment of glucose metabolism in case of the lack of a surgical indication. Recent experience suggests that the combination of different drugs may be able to control cortisol excess in a great majority of patients with CD.

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Section: Predictive Factors For the Outcome Of Pituitary Surgerymentioning

confidence: 99%

Section: Hypopituitarismmentioning

confidence: 99%

The Treatment of Cushing's Disease

et al. 2015

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“…If no adenoma was found, in most instances a partial or total hypophysectomy was performed. 7,15,71 5,15,26,61 With increased removal of pituitary gland tissue, however, there is an increased rate of anterior and posterior pituitary failure.…”

Section: Selective Adenomectomy Compared With Hypophysectomymentioning

confidence: 99%

Transsphenoidal surgery for Cushing's disease: a review of success rates, remission predictors, management of failed surgery, and Nelson's Syndrome

Kelly¹

2007

FOC

100

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✓ Cushing's disease is a serious endocrinopathy that, if left untreated, is associated with significant morbidity and mortality rates. After diagnostic confirmation of Cushing's disease has been made, transsphenoidal adenomectomy is the treatment of choice. When a transsphenoidal adenomectomy is performed at experienced transsphenoidal surgery centers, long-term remission rates average 80% overall, surgical morbidity is low, and the mortality rate is typically less than 1%. In patients with well-defined noninvasive microadenomas, the long-term remission rate averages 90%. For patients in whom primary surgery fails, treatment options such as bilateral adrenalectomy, stereotactic radiotherapy or radiosurgery, total hypophysectomy, or adrenolytic medical therapy need to be carefully considered, ideally in a multidisciplinary setting. The management of Nelson's Syndrome often requires both transsphenoidal surgery and radio-therapy to gain disease control.

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“…Furthermore, the small size of many of the ACTH-producing microadenomas makes this a particularly difficult operation (25). For this reason some surgeons advocate total hypophysectomy, and no recurrence has been reported in 27 patients so treated after 8 to 14 yr follow-up (7,8). However, 23 of these 27 patients are receiving hormone replacement therapy, a far greater proportion than we found after implantation therapy.…”

Section: Discussionmentioning

confidence: 61%

“…Most studies report only short term data on cure and hypopituitarism, and followup has not been long enough to determine if recurrence is a significant problem, as has recently been reported to occur after surgical treatment of prolactinomas (6). After attempted total hypophysectomy most patients require replacement therapy, but a zero or low incidence of recurrence has recently been reported (7)(8)(9). These results contrast with those of heavy particle irradiation, which has been followed by recurrent Cushing's disease in a significant number of patients (10).…”

mentioning

confidence: 99%

Long Term Follow-Up of Patients with Cushing's Disease Treated by Interstitial Irradiation

Sandler

Richards

Carr

et al. 1987

The Journal of Clinical Endocrinology & Metabolism

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The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3-26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred. Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T4 replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years. Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectomy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.

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Long-Term Follow up of Trans-Sphenoidal Hypophysectomy for Cushing's Disease

Cited by 19 publications

References 6 publications

The Treatment of Cushing's Disease

The Treatment of Cushing's Disease

Transsphenoidal surgery for Cushing's disease: a review of success rates, remission predictors, management of failed surgery, and Nelson's Syndrome

Long Term Follow-Up of Patients with Cushing's Disease Treated by Interstitial Irradiation

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