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

55 Citations (Scopus)

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 2012
Externally publishedYes

Fingerprint

Pituitary ACTH Hypersecretion
Petrosal Sinus Sampling
Recurrence
Incidence
Hydrocortisone
Magnetic Resonance Imaging
Adrenal Insufficiency
Microsurgery
Glucocorticoids
Retrospective Studies
Databases

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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

Transsphenoidal surgery for cushing disease : Experience with 136 patients. / Ciric, Ivan; Zhao, Jin Cheng; Du, Hongyan; Findling, James W.; Molitch, Mark E.; Weiss, Roy E; Refetoff, Samuel; Kerr, William D.; Meyer, Joel.

In: Neurosurgery, Vol. 70, No. 1, 01.2012, p. 70-80.

Research output: Contribution to journalArticle

Ciric, I, Zhao, JC, Du, H, Findling, JW, Molitch, ME, Weiss, RE, Refetoff, S, Kerr, WD & Meyer, J 2012, 'Transsphenoidal surgery for cushing disease: Experience with 136 patients', Neurosurgery, vol. 70, no. 1, pp. 70-80. https://doi.org/10.1227/NEU.0b013e31822dda2c
Ciric, Ivan ; Zhao, Jin Cheng ; Du, Hongyan ; Findling, James W. ; Molitch, Mark E. ; Weiss, Roy E ; Refetoff, Samuel ; Kerr, William D. ; Meyer, Joel. / Transsphenoidal surgery for cushing disease : Experience with 136 patients. In: Neurosurgery. 2012 ; Vol. 70, No. 1. pp. 70-80.
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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.",
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AU - Du, Hongyan

AU - Findling, James W.

AU - Molitch, Mark E.

AU - Weiss, Roy E

AU - Refetoff, Samuel

AU - Kerr, William D.

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N2 - 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.

AB - 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.

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KW - Statistical analysis

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