Repeated Transsphenoidal Surgery or Gamma Knife Radiosurgery in Recurrent Cushing Disease After Transsphenoidal Surgery

Bodaghabadi, Mohammad; Riazi, Hooman; Aran, Shima; Bitaraf, Mohammad Ali; Alikhani, Mazdak; Alahverdi, M; Mohamadi, Masoumeh; Shalileh, Keivan; Azar, Maziar

doi:10.1055/s-0033-1345688

Cited by 10 publications

(12 citation statements)

References 20 publications

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“…Bodaghabadi et al . [ 5 ] evaluated 52 patients with relapse of Cushing's disease after initial surgical therapy who were treated with further surgery versus stereotactic radiosurgery (gamma knife). Patients were divided into two balanced groups ( n = 26 each).…”

Section: Resultsmentioning

confidence: 99%

“…Nine patients in the surgery group experienced recurrence, versus 10 patients in the gamma knife group. [ 5 ]…”

Section: Resultsmentioning

confidence: 99%

“…Treatment of pituitary adenomas is often surgical, especially in hormone-secreting tumors or those with a mass effect on surrounding structures, such as the optic chiasm. [ 1 2 3 4 5 ] The presence of residual tumor and tumor recurrence in the postoperative period are not uncommon. Treatment of both conditions remains subject to individual selection since no established guidelines on the type of treatment option for these cases is currently available.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, it is well known that risks are higher in patients subjected to repeated transsphenoidal surgery than in patients without prior therapy. [ 4 5 6 7 8 ] Thus, it is important to conduct a critical analysis of the effect of repeated surgery.…”

Section: Introductionmentioning

confidence: 99%

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Effect of repeated transsphenoidal surgery in recurrent or residual pituitary adenomas: A systematic review and meta-analysis

et al. 2016

Surg Neurol Int

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Background:Recurrent or residual pituitary adenomas previously treated by transsphenoidal surgery are not uncommon. There are no strongly established guidelines to perform treatment of such cases. The objective of this study is to elucidate the effect of transsphenoidal reoperation in residual or recurrent pituitary adenomas.Methods:We made a systematic review of the literature to elucidate this effect through electronic search in MEDLINE/PubMed and Cochrane Central database. PRISMA statement was used as a basis for this systematic review and analysis of the risk of bias was made according to the Grading of Recommendations, Assessment, Development and Evaluation recommendations.Results:In this review, fifteen studies were finally pooled analyzed. Although remission rates (RRs) and follow-up periods varied widely, from 149 patients with growth hormone-secreting tumors the mean RR was 44.5%, from 273 patients with adrenocorticotropic hormone-secreting tumors the mean RR was 55.5% and among 173 patients with nonsecreting tumors, RR was 76.1%. There was significant higher RR in nonsecreting tumors. Mean follow-up was 32.1 months. No difference was found between microscopic and endoscopic techniques.Conclusions:A second transsphenoidal surgery is accompanied by a chance of remission in approximately half of cases with secreting tumors. In nonsecreting ones, success is higher.

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Section: Resultsmentioning

confidence: 99%

“…Nine patients in the surgery group experienced recurrence, versus 10 patients in the gamma knife group. [ 5 ]…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of repeated transsphenoidal surgery in recurrent or residual pituitary adenomas: A systematic review and meta-analysis

et al. 2016

Surg Neurol Int

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“…Pituitary irradiation is usually reserved for patients who have tumor remaining after surgery, for patients who are poor candidates for surgery, and for patients who do not respond adequately to surgery and/or medication. The main disadvantages of radiotherapy are that i) normalization of ACTH secretion may take extended periods of time (eventually years) to occur demanding for medication while success of radiation is awaited, and ii) that patients may develop generalized anterior pituitary insufficiency [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic therapy of Cushing’s syndrome

Eckstein

Haas

Hass

et al. 2014

Orphanet J Rare Dis

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Cushing’s disease (CD) in a stricter sense derives from pathologic adrenocorticotropic hormone (ACTH) secretion usually triggered by micro- or macroadenoma of the pituitary gland. It is, thus, a form of secondary hypercortisolism. In contrast, Cushing’s syndrome (CS) describes the complexity of clinical consequences triggered by excessive cortisol blood levels over extended periods of time irrespective of their origin. CS is a rare disease according to the European orphan regulation affecting not more than 5/10,000 persons in Europe. CD most commonly affects adults aged 20–50 years with a marked female preponderance (1:5 ratio of male vs. female). Patient presentation and clinical symptoms substantially vary depending on duration and plasma levels of cortisol. In 80% of cases CS is ACTH-dependent and in 20% of cases it is ACTH-independent, respectively. Endogenous CS usually is a result of a pituitary tumor. Clinical manifestation of CS, apart from corticotropin-releasing hormone (CRH-), ACTH-, and cortisol-producing (malign and benign) tumors may also be by exogenous glucocorticoid intake. Diagnosis of hypercortisolism (irrespective of its origin) comprises the following: Complete blood count including serum electrolytes, blood sugar etc., urinary free cortisol (UFC) from 24 h-urine sampling and circadian profile of plasma cortisol, plasma ACTH, dehydroepiandrosterone, testosterone itself, and urine steroid profile, Low-Dose-Dexamethasone-Test, High-Dose-Dexamethasone-Test, after endocrine diagnostic tests: magnetic resonance imaging (MRI), ultra-sound, computer tomography (CT) and other localization diagnostics. First-line therapy is trans-sphenoidal surgery (TSS) of the pituitary adenoma (in case of ACTH-producing tumors). In patients not amenable for surgery radiotherapy remains an option. Pharmacological therapy applies when these two options are not amenable or refused. In cases when pharmacological therapy becomes necessary, Pasireotide should be used in first-line in CD. CS patients are at an overall 4-fold higher mortality rate than age- and gender-matched subjects in the general population. The following article describes the most prominent substances used for clinical management of CS and gives a systematic overview of safety profiles, pharmacokinetic (PK)-parameters, and regulatory framework.

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Outcomes of pituitary surgery for Cushing’s disease: a systematic review and meta-analysis

et al. 2020

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Repeated Transsphenoidal Surgery or Gamma Knife Radiosurgery in Recurrent Cushing Disease After Transsphenoidal Surgery

Abstract: With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD.

Cited by 10 publications

References 20 publications

Effect of repeated transsphenoidal surgery in recurrent or residual pituitary adenomas: A systematic review and meta-analysis

Effect of repeated transsphenoidal surgery in recurrent or residual pituitary adenomas: A systematic review and meta-analysis

Systemic therapy of Cushing’s syndrome

Outcomes of pituitary surgery for Cushing’s disease: a systematic review and meta-analysis

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