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[Surgical strategy in Cushing's disease]
1Service de Neurochirurgie, Hôpital Bretonneau, 2, Bd Tonnelle, 37044 Tours Cedex 1.
Annales D'Endocrinologie
|September 6, 2000
Summary
Cushing's disease, caused by pituitary adenomas, is best treated with surgical excision. Early reoperation and a 5-year follow-up are crucial for assessing surgical success and remission rates.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Cushing's disease results from ACTH hypersecretion by pituitary adenomas.
- Surgical excision is the primary curative treatment for this condition.
Purpose of the Study:
- To outline diagnostic and therapeutic strategies for Cushing's disease.
- To evaluate surgical outcomes and risks associated with pituitary adenoma treatment.
Main Methods:
- Diagnosis involves MRI and inferior petrosal sinus ACTH assays.
- Surgical approaches include adenoma excision, and potentially antihypophysectomy.
- Follow-up includes 5-year monitoring of cortisol levels.
Main Results:
- Diagnosis and localization are achieved in 80% of cases using MRI and petrosal sinus sampling.
- Initial remission rates range from 70-85%, with second surgery success rates of 80-90%.
- Surgical risks include CSF fistulae, meningitis, thromboembolism, and visual disturbances.
Conclusions:
- Surgical intervention is the mainstay for Cushing's disease.
- Comprehensive diagnostic workup and appropriate surgical techniques are vital for successful outcomes.
- Careful patient follow-up is essential for long-term management and assessment of cure.