Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years

Neurosurgery
William F ChandlerDavid E Schteingart

Abstract

Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness. To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children. Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded. Patients were categorized for statistical analysis based on tumor size (microadenomas, macroadenomas, and negative imaging) and remission type (type 1 = morning cortisol ≤3 μg/dL; type 2 = morning cortisol normal). Females comprised 78% of patients and were older than men. Imaging showed 50% microadenomas, 13% macroadenomas, and 37% negative for tumor. Remission rates for microadenomas, macroadenomas, and negative imaging were 89%, 66%, and 71%, respectively. Patients with microadenomas were more likely to have type 1 remission. Pathology showed adrenocorticotropic hormone-secreting adenomas in 82% of microadenomas, in 100% of macroadenomas, and in 43% of negative imaging. The incidence of hyperplasia was 8%. The finding of hyperplasia or no tumor on pathology predicted treatment failure. The recurrence rate...Continue Reading

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Citations

Feb 24, 2018·FEBS Letters·Federica CentorrinoChristian Ottmann
Oct 13, 2017·Annals of Pediatric Endocrinology & Metabolism·Ji-Yeon SongYoo-Mi Kim
Nov 21, 2018·Neurosurgical Focus·Todd C HollonStephen E Sullivan
Mar 31, 2018·Journal of the Endocrine Society·Cora BallmannUte I Scholl
Sep 13, 2019·Journal of Internal Medicine·N A Tritos, B M K Biller
Nov 16, 2019·Journal of Clinical Medicine·Hiroshi Nishioka, Shozo Yamada
Nov 28, 2019·Journal of Endocrinological Investigation·A L SerbanE Ferrante
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Aug 1, 2018·Pituitary·Jürgen Honegger, Florian Grimm
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Mar 7, 2020·Best Practice & Research. Clinical Endocrinology & Metabolism·Oskar Ragnarsson
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Sep 15, 2021·Acta neurochirurgica·Bertrand Baussart, Stephan Gaillard
Sep 4, 2021·The Journal of Clinical Endocrinology and Metabolism·Regin Jay MallariDaniel F Kelly

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