Transsphenoidal surgery for cushing disease: Experience with 136 patients

Ivan Ciric, Jin Cheng Zhao, Hongyan Du, James W. Findling, Mark E. Molitch, Roy E. Weiss, Samuel Refetoff, William D. Kerr, Joel Meyer

Research output: Contribution to journalArticle

58 Scopus citations

Abstract

BACKGROUND: This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery. OBJECTIVE: To evaluate factors influencing immediate postoperative results and longterm outcomes. METHODS: Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and longterm results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency. RESULTS: IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 mg/dL (range, < 0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P <.001) and with 4.1 times greater odds of IPBR (P =.07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P =.004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean followup in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P =.08). CONCLUSION: In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 mg/dL may be associated with higher incidence of recurrences.

Original languageEnglish (US)
Pages (from-to)70-80
Number of pages11
JournalNeurosurgery
Volume70
Issue number1
DOIs
StatePublished - Jan 1 2012

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Keywords

  • Cushing disease
  • Immediate postoperative remission
  • Long-term results
  • Statistical analysis
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Ciric, I., Zhao, J. C., Du, H., Findling, J. W., Molitch, M. E., Weiss, R. E., Refetoff, S., Kerr, W. D., & Meyer, J. (2012). Transsphenoidal surgery for cushing disease: Experience with 136 patients. Neurosurgery, 70(1), 70-80. https://doi.org/10.1227/NEU.0b013e31822dda2c