Transsphenoidal pituitary surgery in Cushing's disease: can we predict outcome?

Chee, Gerard H; Mathias, D.; James, Roberta; Kendall‐Taylor, P.

doi:10.1046/j.1365-2265.2001.01261.x

Cited by 165 publications

(129 citation statements)

References 33 publications

(61 reference statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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Corticotroph pituitary carcinomas are tumors, defined by the presence of distant metastases that determine their poor prognosis. The diagnosis and therapy of malignant corticotroph adenomas remains a clinical challenge. The molecular mechanisms of malignant transformation of pituitary adenomas are unclear, although they are believed to arise in an adenoma-to-carcinoma sequence. We describe two cases of malignant Cushing's disease with metastases in liver and bone, respectively. The primary pituitary tumors were treated by a combination of radiotherapy and transsphenoidal surgery, but recurred several times in both patients. The time interval between the diagnosis of Cushing's disease and the discovery of metastases was 32 and 17 years, respectively. In the first case the patient died within 6 months after diagnosis of metastasis, whereas the second patient is alive at a followup of 2 years after the discovery of the metastasis. Furthermore, we reviewed all available cases of corticotroph pituitary carcinomas reported in the literature and analyzed their clinical features and therapeutical management. In conclusion, frequent relapses of Cushing's disease, aggressive growth of macroadenoma, Nelson's syndrome after adrenalectomy or persistently high ACTH levels should prompt the clinician to consider the possibility of pituitary corticotroph carcinomas.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…A variety of definitions of remission of Cushing's disease after initial microscopic TSS is used in the literature: symptoms of hypercortisolism remitted (25), a continuous need for corticosteroid replacement for O6 months after TSS (26), no need for additional treatment because of clinical remission of the disease (27), resolution of symptoms and signs of hypercortisolism (28) or of clinical features (16,19), clinical evidence of eucortisolemia (23), appearance of clinical signs of adrenal insufficiency (29), regression of the clinical signs (30), presence of clinical and laboratory signs of adrenal insufficiency (17,22), and reversal of the clinical stigmata (31). Clinical parameters were never used alone to define remission; clinical evaluation was always combined with serum cortisol, UFC, and/or LDDST biochemical tests ( Table 1).…”

Section: Remission Ratesmentioning

confidence: 99%

“…Higher remission rates are generally reported in patients with discrete, easily operated tumors, with improved outcomes achieved with microadenomas vs macroadenomas (6,13,15,16,17,18) and with adenomas identified at surgery or by radiology or histopathology vs no adenomas identified (19,20). Other factors suggested to increase the success of initial TSS include extensive surgical experience and younger patient age (!25 years) (6).…”

Section: Introductionmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence

Petersenn¹,

Beckers²,

Ferone³

et al. 2015

European Journal of Endocrinology

125

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Objective: A number of factors can influence the reported outcomes of transsphenoidal surgery (TSS) for Cushing's diseaseincluding different remission and recurrence criteria, for which there is no consensus. Therefore, a comparative analysis of the best treatment options and patient management strategies is difficult. In this review, we investigated the clinical outcomes of initial TSS in patients with Cushing's disease based on definitions of and assessments for remission and recurrence. Methods: We systematically searched PubMed and identified 44 studies with clear definitions of remission and recurrence. When data were available, additional analyses by time of remission, tumor size, duration of follow-up, surgical experience, year of study publication and adverse events related to surgery were performed. Results: Data from a total of 6400 patients who received microscopic TSS were extracted and analyzed. A variety of definitions of remission and recurrence of Cushing's disease after initial microscopic TSS was used, giving broad ranges of remission (42.0-96.6%; median, 77.9%) and recurrence (0-47.4%; median, 11.5%). Better remission and recurrence outcomes were achieved for microadenomas vs macroadenomas; however, no correlations were found with other parameters, other than improved safety with longer surgical experience.

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“…A taxa de remissão após CTE observada em bons centros varia entre 53%-96% (9,(25)(26)(27)(28), chegando a 96% nos microadenomas (26) e tão baixas quanto 53% nos macroadenomas (27). Além disso, as taxas de cura na segunda CTE são inferiores às da primeira CTE e variam em torno de 28%-67% (9,28-31), já as chances de hipopituitarismo aumentam nas reintervenções, alcançando taxas de 46%-100% após a segunda CTE (28)(29)(30)(31).…”

Section: Terapêutica Da Doença De Cushingunclassified

Avaliação do eixo hipotálamo-hipófise adrenal no diagnóstico e na remissão da doença de Cushing

Costenaro

Rodrigues

Rollin

et al. 2012

Arq Bras Endocrinol Metab

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A doença de Cushing (DC) permanece um desafio médico com muitas questões ainda não respondidas. O sucesso terapêutico dos pacientes com DC está ligado à correta investigação do diagnóstico síndrômico e etiológico, além da experiência e talento do neurocirurgião. A adenomectomia hipofisária transesfenoidal constitui-se no tratamento de escolha para a DC. A avaliação da remissão da doença no pós-operatório e da recorrência em longo prazo constitui um desafio ainda maior. Especial destaque deve ser dado para o cortisol sérico no pós-operatório como marcador de remissão. Adicionalmente, o uso de corticoide exógeno no pós-operatório apenas em vigência de insuficiência adrenal tem sido sugerido por alguns autores como requisito essencial para permitir a correta interpretação do cortisol sérico nesse cenário. Neste artigo, revisamos as formas de avaliação da atividade da DC e os marcadores de remissão e recidiva da DC após a realização da cirurgia transesfenoidal. Arq Bras Endocrinol Metab. 2012;56(3):159-67 Descritores Doença de Cushing; cortisol sérico; remissão; cirurgia hipofisária summArY Cushing's disease (CD) remains a medical challenge, with many questions still unanswered. Successful treatment of CD patients is closely related to correct approach to syndromic and etiological diagnosis, besides the experience and talent of the neurosurgeon. Pituitary transsphenoidal adenomectomy is the treatment of choice for DC. Assessment of remission after surgery and recurrence in the long term is an even greater challenge. In this regard, special attention should be paid to the role of postoperative serum cortisol as a marker of CD remission. Additionally, the postoperative use of exogenous glucocorticoids only in cases of adrenal insufficiency has been suggested by some authors as an essential practice to enable the use of serum cortisol in this scenario. In this article, we review the forms of evaluation of DC activity, and markers of remission and relapse of CD after transsphenoidal surgery. iNTroDuÇÃo A doença de Cushing (DC) apresenta incidência estimada de 0,7 a 3 casos/milhão/ano (1-3), com prevalência de 39,1 casos por milhão de habitantes (4). Acomete adultos jovens com pico de incidência entre a terceira e quarta décadas de vida (5) e predominantemente mulheres.Para o sucesso no manejo desses pacientes, é necessário que a investigação diagnóstica obedeça a uma sequência lógica: inicialmente o diagnóstico sindrômico e posteriormente o diagnóstico etiológico.O risco relativo de morbidade e mortalidade na DC é de 2 a 5 vezes acima da população em geral (2,3), podendo equiparar-se ao risco da população em geral durante a remissão da doença (2).

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Transsphenoidal pituitary surgery in Cushing's disease: can we predict outcome?

Cited by 165 publications

References 33 publications

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

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

THERAPY OF ENDOCRINE DISEASE: Outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence

Avaliação do eixo hipotálamo-hipófise adrenal no diagnóstico e na remissão da doença de Cushing

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