The Value of Intraoperative Cytology During Transsphenoidal Surgery for ACTH-Secreting Microadenoma

Kurosaki, Masamichi; Luedecke, Dieter K.; Knappe, Ulrich J.; Flitsch, Jörg; Saeger, Wolfgang

doi:10.1007/s007010070071

Cited by 19 publications

(11 citation statements)

References 26 publications

(21 reference statements)

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“…Recently, we therefore evaluated a direct intraoperative micromethod for hormone measurements of pituitary tissue in Cushing's disease (Flitsch et al, 1999). During surgery, we are able to specifically prove the ACTH secretion of adenomas documented by intraoperative cytology (Kurosaki et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, the floor of the sella was opened up to both rims of the cavernous sinus for optimal access and in order to allow blood draws from the cavernous sinus for intraoperative ACTH measurements. During careful exploration of the pituitary, microbiopsies of adenoma-suspicious tissue were taken for intraoperative cytology and ACTH measurements of pituitary tissue (Flitsch et al, 1999;Kurosaki et al, 2000). After the adenomectomy was finished, the patients were routinely transferred to our intensive care unit for one night.…”

Section: Transsphenoidal Surgery and Postoperative Coursementioning

confidence: 99%

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Cavernous Sinus Sampling in Selected Cases of Cushing's Disease

Flitsch¹,

Dk²,

Uj³

et al. 2002

Exp Clin Endocrinol Diabetes

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The classical trias in Cushing's disease, normal or moderately elevated plasma ACTH, significant suppression of cortisol in the high-dose dexamethasone test, and stimulation of ACTH and cortisol in the CRH test, confirms the diagnosis in most cases. However, as a referral centre for complex Cushing's disease cases, we are confronted with problems in the differentiation of pituitary and ectopic Cushing's syndrome and with problems in the localisation of minute ACTH-secreting pituitary adenomas. In this study, cavernous sinus sampling (CSS) was evaluated as a diagnostic tool in complex Cushing's disease cases. Thirty-five patients were transferred to our unit for the treatment of Cushing's disease between January 1999 and August 2000. Of those, 17 patients (including five children) had the combination of equivocal results in endocrinological testing and negative MRI prior to admission. In these cases, CSS was performed preoperatively to confirm the diagnosis and to obtain further information about the localisation of pituitary microadenomas. Twelve of these 17 patients showed the classical trias for Cushing's disease after equivocal tests were repeated. A central-peripheral gradient was also found using CSS. In ten of the 11 patients, where CSS could be successfully performed, the lateralisation of the ACTH-adenoma was correctly predicted (91%). In the eleventh case, a right ACTH-gradient was found in a stalk tumour. In one patient (a child), the catheterisation of the cavernous sinus failed due to anatomical reasons. Eleven of these 12 patients successfully underwent transnasal adenomectomy. In two of the 17 patients, active Cushing's syndrome was excluded. In the remaining three cases, ectopic Cushing's syndrome was suspected based on CSS results. Therefore, these patients did not undergo pituitary exploration. In complex cases, we recommend CSS for diagnostic purposes, especially for the localisation of ACTH-secreting microadenomas within the pituitary. In our experience, CSS has a higher accuracy than inferior petrosal sinus sampling (IPSS) in the localisation of ACTH-adenomas.

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Section: Discussionmentioning

confidence: 99%

Section: Transsphenoidal Surgery and Postoperative Coursementioning

confidence: 99%

Cavernous Sinus Sampling in Selected Cases of Cushing's Disease

Flitsch¹,

Dk²,

Uj³

et al. 2002

Exp Clin Endocrinol Diabetes

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“…Four patients had no evidence for pituitary tumor on preoperative MRI. In CD identifi cation of ACTH-secreting adenomas and selective adenomectomy are associated with high remission rates of hypercortisolism and low incidence of postoperative hypopituitarism [7,11,16,26] . In MRI-negative cases, venous inferior petrosal sinus sampling (IPSS) for detection of centro-to-peripheral ACTH-gradient is helpful in establishing the diagnosis of CD [3,20] .…”

Section: Endocrinological Outcomementioning

confidence: 99%

Ultrasound-assisted Microsurgery for Cushing's Disease

Knappe

Engelbach²,

Konz

et al. 2009

Exp Clin Endocrinol Diabetes

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“…Microdoppler was used to identify the actual position of the carotid artery. In questionable areas, tiny samples of tumor-suspicious tissue were investigated using a smear technique during surgery or frozen section in cases with firm tissue [19].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

2003

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Abstract. Transsphenoidal surgery is the first therapeutic option in acromegaly, but the management of persistent or recurrent cases of the disease after surgery has been controversial. This study presented the results of secondary transnasal surgery for residual or recurring growth hormone (GH)-secreting macroadenoma with reference to intraoperative GH measurement. It focused on 22 patients who underwent secondary transsphenoidal surgery for 18 residual and 4 recurring GH-secreting pituitary macroadenomas from 1990 to 1999. To assess complete tumor removal, plasma GH concentration was measured intraoperatively. Before secondary surgery, plasma GH levels without medical treatment ranged from 2.0 to 239.0 mg/l (mean 31.5 +/-50.4). Magnetic resonance imaging demonstrated 16 transnasally resectable tumors and 6 nonresectable grossly invasive tumors. Intraoperative plasma GH concentrations declined sufficiently in 9 of 16 with transnasally resectable tumors, but in the remaining 7 cases the tumors were further explored and normalization of GH levels was ultimately obtained in 4 out of these cases. It was impossible to completely remove the tumors in all the 6 patients with transnasally nonresectable tumors. Thirteen of 22 patients achieved endocrinological remission by rigorous criteria. In transnasally resectable tumors, the endocrinological remission rate was 81.3% (13 of 16 patients) with no recurrence during the follow-up period of at least 4 years. Secondary transnasal surgery for residual or recurring GHsecreting pituitary macroadenomas is a safe and effective treatment, if done along with intraoperative GH measurement. Endocrinological remission can be obtained with high probability in patients who suffer from macroadenomas with suprasellar extension, with the exception of transnasally nonresectable grossly invasive tumors.

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The Value of Intraoperative Cytology During Transsphenoidal Surgery for ACTH-Secreting Microadenoma

Abstract: The method described here was particularly well suited for the intraoperative discrimination and documentation of minute adenomas. Cytological preparation appears to be effective in improving the adenoma finding rate and the surgical outcome in cases of Cushing's disease.

Cited by 19 publications

References 26 publications

Cavernous Sinus Sampling in Selected Cases of Cushing's Disease

Cavernous Sinus Sampling in Selected Cases of Cushing's Disease

Ultrasound-assisted Microsurgery for Cushing's Disease

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

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