[Treatment of Cushing's disease. Transsphenoidal surgery and pituitary radiotherapy]

Transsphenoidal surgery is currently considered the treatment of choice for Cushing's disease. Initial remission is achieved in approximately 70-85%, but 10-15% of patients with remission will suffer a recurrence months or years later. Pituitary irradiation has been used as a therapeutic tool for many years. Nowadays, this option is considered a second-line treatment, to be used when there is postsurgical persistence or recurrence of the disease. The present article reviews the surgical approaches, remission rates reported by different groups, prognostic factors, and the most frequent complications after transsphenoidal surgery. We also review the different techniques that can be used for pituitary irradiation, as well as the efficacy and morbidity reported for each of these techniques in patients with Cushing's disease.