Results of repeated transsphenoidal surgery in Cushing's disease. Long-term follow-up

Valderrábano, Pablo; Aller, Javier; García-Valdecasas, Leopoldo; García-Uria, José; Martín, Laura Domínguez; Palacios, Nuria; Estrada, Javier

doi:10.1016/j.endonu.2013.10.008

Cited by 34 publications

(22 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Importantly, the risk of hypopituitarism after repeat pituitary surgery appears to be lower than that reported to occur several years after radiotherapy (264,265). Postoperative CSF leak has been reported to be more frequent after repeat TSS than after the initial TSS (range, 3.2-83.3%; mean, 28.7%; median, 15.9%) (147,148,170,271,275,276). The rate of PDI ranges between 3.2 and 83.3% (mean, 24.7%; median, 11.1%) (123,147,148,271,274), whereas the rate of TDI ranges between 5.5 and 42.8% (mean, 23.1%; median, 22.1%) (271, 274 -276).…”

Section: A Repeat Pituitary Surgerymentioning

confidence: 81%

“…The rate of hypopituitarism described in studies on repeat pituitary surgery, which report the general rate of hypopituitarism, varies between 9.1 and 78.6% (mean, 38%; median, 37%) (123,147,271,275,276). Different studies, however, reported the rate of the various pituitary deficiencies after repeat TSS; on the basis of these data, hypothyroidism ranges between 11.8 and 57.1% (mean, 30%; median, 21%) (147,275,276), hypogonadism ranges between 11.8 and 21.4% (mean, 16.4%; median, 16%) (147,275,276), and GH deficiency ranges between 21 and 28.6% (mean and median, 24.8%) (275,276), whereas panhypopituitarism ranges between 5.2 and 83.3% (mean, 31.3%; median, 5.5%) (148,274,276). Importantly, the risk of hypopituitarism after repeat pituitary surgery appears to be lower than that reported to occur several years after radiotherapy (264,265).…”

Section: A Repeat Pituitary Surgerymentioning

confidence: 97%

“…Serial testing over a period of 1-2 months might be advised, before considering additional therapy in patients who improve but are not in a clear-cut remission immediately after the initial surgery (141). A delayed reoperation, which is performed at least 60 days after the initial surgery, is associated with remission rate ranging between 30 and 71.4%, with mean and median remission rates of 51.5 and 46.2%, respectively (123,160,166,170,171,(271)(272)(273)(274)(275)(276). The remission rate associated with a second operation is lower than that obtained after the first operation and may vary on the basis of tumor features, including the size and location of the residual pituitary tumor (264 -268, 274).…”

Section: A Repeat Pituitary Surgerymentioning

confidence: 98%

“…The rate of PDI ranges between 3.2 and 83.3% (mean, 24.7%; median, 11.1%) (123,147,148,271,274), whereas the rate of TDI ranges between 5.5 and 42.8% (mean, 23.1%; median, 22.1%) (271, 274 -276). Finally, the rate of meningitis ranges between 3.8 and 8.3% (mean, 6.8%; median, 8.2%) (148,271,276).…”

Section: A Repeat Pituitary Surgerymentioning

confidence: 99%

See 3 more Smart Citations

The Treatment of Cushing's Disease

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Section: A Repeat Pituitary Surgerymentioning

confidence: 81%

Section: A Repeat Pituitary Surgerymentioning

confidence: 97%

Section: A Repeat Pituitary Surgerymentioning

confidence: 98%

Section: A Repeat Pituitary Surgerymentioning

confidence: 99%

See 2 more Smart Citations

The Treatment of Cushing's Disease

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The percentage of patients developing hypopituitarism after the first TSS varies from 2 to 48% and this number increases in case of repeated TSS [16]. Repeated TSS is also associated with lower remission rates [17,18]. Radiotherapy can be applied as alternative approach in case of recurrence or persistent hypercortisolism.…”

Section: Introductionmentioning

confidence: 97%

Cushing’s syndrome: an update on current pharmacotherapy and future directions

Creemers

Hofland

Lamberts

et al. 2015

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

The number of medical treatment options for CS has increased in the past years. In contrast to decades ago, prospective trials are now being performed focusing on pituitary-directed drugs like pasireotide, the glucocorticoid receptor blocker mifepristone and 'new generation' steroid synthesis inhibitors. Future studies will focus on tumor-shrinking effects of neuromodulatory drugs, the optimal order and combination of pharmacotherapy, long-term efficacy and safety and new targets for medical treatment of CS.

show abstract