Long-term remission and recurrence rates in Cushing's disease: predictive factors in a single-centre study

Abstract

Objective: To investigate the early and late outcomes of patients with Cushing's disease (CD) submitted to a neurosurgical procedure as first-line treatment. Design: In this single-centre retrospective case notes study, 131 patients with CD with a minimum follow-up period of 6 years (124 operated by transsphenoidal surgery (TSS) and seven by the transcranial approach) were studied. Apparent immediate cure: post-operative 0900 h serum cortisol level !50 nmol/l; remission: cortisol insufficiency or restoration of 'normal' cortisol levels with resolution of clinical features; and recurrence: dexamethasone resistance and relapse of hypercortisolaemic features. Results: In patients operated by TSS, remission of hypercortisolaemia was found in 72.8% of 103 microadenomas and 42.9% of 21 macroadenomas, with recurrence rates 22.7 and 33.3% respectively with a 15-year mean follow-up (range, 6-29 years). Of 27 patients with microadenomas operated after 1991, with positive imaging and pathology, 93% obtained remission with 12% recurrence. In multivariate analysis, the time needed to achieve recovery of hypothalamo-pituitary-adrenal axis was the only significant predictor of recurrence; all patients who recurred showed recovery within 3 years from surgery: 31.3% of patients had total hypophysectomy with no recurrence; 42% of patients with selective adenomectomy and 26.5% with hemi-hypophysectomy showed recurrence rates of 31 and 13% respectively (c 2 Z6.275, PZ0.03). Strict remission criteria were not superior in terms of the probability of recurrence compared with post-operative normocortisolaemia. Conclusions: Lifelong follow-up for patients with CD appears essential, particularly for patients who have shown rapid recovery of their axis. The strict criteria previously used for 'apparent cure' do not appear to necessarily predict a lower recurrence rate.

Cushing's disease: pathobiology, diagnosis, and management

“…Partial and total hypophysectomies have similar biochemical remission rates (60% to 80%) ( Table 2). 2,11,29,42,85,104 While partial hypophysectomy permits most patients to retain normal pituitary function, pituitary function is permanently abolished after total hypophysectomy.…”

“…Since 2010, surgical series generally show remission rates between 65% and 85% and recurrence rates of 10%-35% (Table 1). [1][2][3]5,8,20,24,25,27,41,44,53,86,97,99,101,107 Surgical success and recurrence rates depend on surgeon experience, as well as the criteria used to define cure and length of follow-up.…”

Factors affecting the probability of recurrence of the Cushing’s disease within 3 years after effective neurosurgical treatment

“…Эндоскопическая трансна-зальная транссфеноидальная аденомэкто-мия является методом выбора в лечении БИК [3][4][5]. Несмотря на высокие показатели ремиссии -порядка 60-90% [6][7][8][9], частота рецидивов заболевания после первоначаль-но успешной (с развитием послеоперацион-ной ремиссии) трансназальной аденомэкто-мии варьирует от 10 до 65% [10][11][12][13]. Большая часть рецидивов возникает в первые 2-4 года после трансназальной аденомэктомии [14,15].…”

“…Большая часть рецидивов возникает в первые 2-4 года после трансназальной аденомэктомии [14,15]. В ряде работ оценены факторы, влияющие на развитие рецидива заболева-ния: послеоперационные уровни АКТГ и кор-тизола, визуализация аденомы по данным 1,5 Тл МРТ, размер и инвазия аденомы гипо-физа, в то время как возраст, длительность заболевания не оказывают влияния на веро-ятность возникновения рецидива [6,7,10,14,15,[19][20][21][22].…”

Pasireotide versus pituitary surgery: a retrospective analysis of 12 months of treatment in patients with Cushing’s disease

“…Pituitary surgery represents the first-line treatment for most patients with Cushing's disease (CD) [1,2].…”