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[Indications for total hypophysectomy in Cushing's disease]
M Jan1, P François, J Trouillas
1Service de Neurochirurgie, CHU Bretonneau, 37044 Tours Cedex 1, France. micheljan@med.univ-tours.fr
Neuro-Chirurgie
|June 12, 2002
Summary
Total hypophysectomy is a viable treatment for Cushing's disease when MRI is normal, but it frequently causes complications. Inferior petrosal sinus sampling may help localize adenomas to reduce risks.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Transsphenoidal selective adenomectomy is standard for Cushing's disease.
- Magnetic resonance imaging (MRI) can fail to detect small pituitary ACTH-secreting adenomas.
- Total hypophysectomy is an option when MRI is normal.
Purpose of the Study:
- To evaluate the outcomes and complications of total hypophysectomy for Cushing's disease.
- To assess the efficacy of total hypophysectomy in cases with normal MRI findings.
Main Methods:
- Retrospective analysis of 7 patients with Cushing's disease and normal MRI who underwent total hypophysectomy.
- Inclusion criteria: clinical and biochemical evidence of Cushing's disease with normal MRI.
Main Results:
- Five of seven patients had histologically confirmed ACTH-secreting adenomas.
- Six patients experienced complications, including cerebrospinal fluid fistulas (6), meningitis (5), anterior pituitary insufficiency (5), diabetes insipidus (5), and vision loss (1).
- Six patients achieved sustained remission at 36 months post-surgery.
Conclusions:
- Total hypophysectomy is a feasible treatment for Cushing's disease when MRI is normal.
- High complication rates, particularly CSF fistulas, are associated with total hypophysectomy.
- Inferior petrosal sinus sampling can aid in adenoma localization, potentially enabling hemihypophysectomy and reducing morbidity.