Long‐term follow‐up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission

Abstract

Transsphenoidal surgery is a safe and effective treatment for Cushing's disease and our results compare favourably with those from published series, the majority of which comprise relatively small numbers. The presence of an intrasellar lesion and postoperative serum cortisol < 50 nmol/l are good predictors of remission in the long term but historically in our centre this can only be achieved in a significant number of patients at the expense of some degree of hypopituitarism. However, the surgical outcome for Cushing's disease, including a reduced frequency of hypopituitarism, can be improved if patients are operated on by a single pituitary surgeon, using selective adenomectomy as the preferred surgical approach wherever possible.

Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature

“…In the reported cases CD recurred at least one time in 55% of cases. However, recurrence of benign Cushing's disease after initial surgical cure also occurs in 5-36% of the patients during long-term follow-up [52][53][54][55][56][57]. Furthermore, growth of the pituitary tumor occurred in 67% of the reported cases that were treated with bilateral adrenalectomy as primary treatment.…”

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

“…8 Overall, the remission rates reported after second TS in persistent or recurrent CD seem to be slightly lower than the remission rates reported after first TS which vary from 50% to 90%, but are mostly 70-85%. [3][4][5][6][7][8][9] Nevertheless, the majority of the patients with persistent or recurrent CD can still instantly be cured by repeated TS, and the remission rate we achieved via the endoscopic technique seems to be at least as good as the remission rate achieved by repeated TS via the conventional microscopic technique.…”

“…6,7,10 Relapse was defined as development of clinical symptoms of hypercortisolism and inadequate suppression of plasma cortisol level after an overnight 1 mg dexamethasone suppression test in patients who were in remission after the first surgery according to the previously mentioned criteria.…”

“…However, CD persists in the remaining patients, and 5-25% of the patients who are initially in remission develop a recurrence. [3][4][5][6][7][8] Treatment options for persistent or recurrent CD include radiation therapy, bilateral adrenalectomy, medical therapy and repeated TS. Thus far, no consensus exists on which therapy is preferable.…”

Cyclic Cushing's Syndrome: An Overview

“…Pituitary neurosurgery is the first-line treatment for ACTH-secreting pituitary adenomas. Experienced surgeons achieve an initial biochemical remission in 70-80% of cases, but a significant number of recurrences are seen during long-term follow-up, the rate ranging between 9% and 23% (48,49). Pituitary radiation is reserved for patients failing to respond to surgery, but this treatment may only be effective after several years and it causes a high rate of pituitary insufficiency (50).…”