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Contemporary microsurgical concept for the treatment of Cushing’s disease: endocrine outcome in 83 consecutive patients
Author(s) -
Honegger Juergen,
Schmalisch Kathrin,
Beuschlein Felix,
Kaufmann Sarah,
Schnauder Guenter,
Naegele Thomas,
Psaras Tsambika
Publication year - 2012
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2011.04268.x
Subject(s) - medicine , hypopituitarism , cushing's disease , adenoma , diabetes insipidus , occult , pituitary adenoma , transsphenoidal surgery , surgery , endocrine system , microsurgery , disease , hormone , pathology , alternative medicine
Summary Background Evidence suggests that occult adenoma remnants are responsible for persistent Cushing’s disease (CD) following transsphenoidal surgery (TSS). To optimize the outcome, we have adapted our microsurgical concept. The influence of our surgical strategy on remission rate and pituitary function is presented. Design and patients 83 patients undergoing TSS for newly diagnosed CD. An enlarged resection was performed in 36 patients. A modified exploration technique with radial incisions was performed in 19 patients in whom an adenoma was not readily detectable. Results The overall remission rate of primary surgery was 84·3% (70/83). A remission rate of 87·5% (63/72) was achieved in microadenomas. Six patients with microadenomas were re‐operated for persistence, and hypercortisolism was corrected in five of them. With re‐operation included, the overall remission rate for microadenomas was 94·4%. No procedure‐related complications occurred in primary surgery. Of the patients in remission, 72·5% had early postoperative random cortisol levels below 2 μg/dl, 17·4% had cortisol levels between 2 and 5 μg/dl, and 10·1% had cortisol levels >5 μg/dl. 15·2% of the patients with microadenomas developed postoperative partial hypopituitarism and 3% diabetes insipidus. No increased rate of hypopituitarism was found with enlarged adenomectomy compared to selective adenomectomy. Only a slightly higher rate of partial hypopituitarism (23·1%) was found if extensive exploration was required. Conclusion With our microsurgical concept, a high initial cure rate is achievable with minimal surgical morbidity. Enlarged adenomectomy has no adverse effect on the rate of postoperative hypopituitarism. Early repeat surgery is a successful option if CD persists.