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Updated: Aug 30, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Surgical treatment and follow-up results of pituitary ACTH microadenoma: 18 years' experience
Weiguo Zhao1, Shikuen Zhan, Yu Cai
1Department of Neurosurgery, Rui Jin Hospital of Shanghai Second Medical University, Shanghai, People's Republic of China. rjneurosurgery@yahoo.com.cn
Objective:
To review retrospectively our clinical experience with surgical treatment and follow-up of pituitary adrenocorticotropic hormone (ACTH) microadenomas at Rui Jin Hospital of Shanghai Second Medical University.
Methods:
Eighty-seven patients with ACTH microadenomas underwent surgery via the transsphenoidal approach. Preoperative computed tomography and/or magnetic resonance imaging revealed microadenomas in only 46 patients and was negative in the remaining 41 patients, which were classified as microadenoma grade 0. High-dose dexamethasone (Dx) suppression testing was positive in 86% of patients and low-dose Dx suppression testing was negative in all patients.
Results:
Histological confirmation of ACTH microadenoma was made in all 87 cases, with a minimum tumour size of only 1 to 2 mm in diameter. The remission rate was 82% for grade I and 92% for grade 0 microadenomas during 2 to 18 years of follow-up.
Conclusions:
Neuroimaging studies have limited value in diagnosing ACTH grade 0 microadenoma. Clinical manifestation combined with positive Dx suppression testing is decisive in these circumstances. Surgical intervention could achieve a high relief rate for ACTH microadenomas, especially in grade 0 group.
Insights
Surgical treatment of pituitary adrenocorticotropic hormone (ACTH) microadenomas shows high remission rates, particularly for grade 0 tumors. Clinical findings and dexamethasone testing are crucial for diagnosing ACTH grade 0 microadenomas.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Pituitary adrenocorticotropic hormone (ACTH) microadenomas are small tumors.
- Accurate diagnosis and effective treatment are essential for patient outcomes.
Purpose of the Study:
- To review clinical experience with surgical treatment and follow-up of pituitary ACTH microadenomas.
- To evaluate the effectiveness of the transsphenoidal approach for these tumors.
Main Methods:
- Retrospective review of 87 patients with ACTH microadenomas treated surgically.
- Transsphenoidal surgery was performed.
- Preoperative imaging and dexamethasone suppression testing were utilized.
Main Results:
- Histological confirmation of ACTH microadenoma in all 87 cases.
- Remission rates were 82% for grade I and 92% for grade 0 microadenomas.
- High-dose dexamethasone suppression testing was positive in 86% of patients.
Conclusions:
- Neuroimaging has limited value for diagnosing ACTH grade 0 microadenoma.
- Clinical manifestation and positive dexamethasone suppression testing are decisive for diagnosis.
- Surgical intervention achieves high remission rates, especially for grade 0 ACTH microadenomas.
