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Recurrent Cushing's disease after transsphenoidal surgery
1Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, OH 44195.
Archives of Internal Medicine
|May 1, 1992
Summary
Cushing's disease recurrence after transsphenoidal surgery is notable, occurring in 20.6% of patients. Long-term monitoring with urinary free cortisol is recommended to detect delayed recurrences.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Cushing's disease is a serious endocrine disorder caused by excess cortisol.
- Transsphenoidal surgery is a primary treatment for pituitary adenomas causing Cushing's disease.
Purpose of the Study:
- To evaluate the long-term recurrence rate of Cushing's disease after transsphenoidal surgery.
- To identify factors influencing recurrence and optimal follow-up strategies.
Main Methods:
- Retrospective analysis of 34 patients with Cushing's disease treated with transsphenoidal surgery.
- Clinical and biochemical evaluation for disease recurrence.
- Assessment of postoperative adrenal insufficiency and duration of steroid replacement.
Main Results:
- Biochemical remission was achieved in all 34 patients postoperatively.
- Seven patients (20.6%) experienced disease recurrence.
- Recurrence times ranged from 29 to 62 months (mean 40 months).
- All recurrent cases involved pituitary adenomas and required prolonged steroid replacement.
Conclusions:
- The recurrence rate of Cushing's disease after surgery is significant (20.6%).
- Longer follow-up periods correlate with a higher incidence of recurrence.
- Yearly urinary free cortisol testing is recommended for early detection of delayed recurrences.