Transsphenoidal surgery for Cushing disease: experience with 136 patients.

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Background:

• Cushing disease is a rare endocrine disorder caused by excess cortisol production, often due to pituitary adenomas.
• Transsphenoidal microsurgery is a primary treatment modality for Cushing disease.

Purpose of the Study:

• To evaluate factors influencing immediate postoperative results and long-term outcomes in patients with Cushing disease undergoing transsphenoidal microsurgery.
• To identify predictors of biochemical remission and recurrence.

Main Methods:

• Retrospective analysis of 136 patients with Cushing disease treated with transsphenoidal microsurgery.
• Data collected included clinical presentation, endocrine evaluation, imaging, surgical technique, and outcomes.
• Statistical analysis was performed to assess factors affecting immediate postoperative biochemical remission (IPBR) and long-term results.

Main Results:

• Overall IPBR was 83.4%. For microadenomas, IPBR was 89.8%, with positive MRI significantly increasing the odds of finding the adenoma and achieving IPBR.
• Positive inferior petrosal sinus sampling (IPSS) test in patients with negative MRI was associated with 93% IPBR.
• Macroadenomas had a lower IPBR of 30.7%. Long-term follow-up revealed 34.8% required glucocorticoid replacement, and recurrence increased over time, potentially linked to higher immediate postoperative plasma cortisol (IPPC).

Conclusions:

• Positive MRI and IPSS are associated with higher IPBR in microadenomas.
• Recurrence rates increase with time, and elevated IPPC may predict higher recurrence risk.
• Transsphenoidal microsurgery is effective, but long-term monitoring is crucial for managing recurrences and potential adrenal insufficiency.