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Repeat transsphenoidal surgery for Cushing's disease.

R B Friedman1, E H Oldfield, L K Nieman

  • 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.

Journal of Neurosurgery
|October 1, 1989
PubMed
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Repeat transsphenoidal surgery can effectively treat recurrent Cushing's disease, achieving remission in 73% of patients. Selective adenomectomy offers high remission rates with low hypopituitarism risk, making it a key consideration for persistent hypercortisolism.

Area of Science:

  • Endocrinology
  • Neurosurgery
  • Oncology

Background:

  • Transsphenoidal resection of adrenocorticotrophic hormone (ACTH)-producing pituitary adenomas is a primary treatment for Cushing's disease.
  • While often curative, surgery may not always be successful, leading to persistent or recurrent hypercortisolism.
  • The efficacy of repeat pituitary surgery for these cases has not been previously evaluated.

Purpose of the Study:

  • To determine the effectiveness of transsphenoidal surgery in patients with recurrent or persistent Cushing's disease.
  • To assess remission rates and complication risks associated with repeat pituitary surgery.

Main Methods:

  • Transsphenoidal surgery was performed on 33 patients with recurrent or persistent Cushing's disease.
  • These included 31 patients with prior transsphenoidal operations and 2 with prior pituitary irradiation.

Related Experiment Videos

  • Preoperative imaging (CT scans) and intraoperative findings were analyzed.

    • Main Results:

    • Surgery achieved remission of hypercortisolism in 24 (73%) of the 33 patients.
    • Identifying a discrete adenoma during surgery and performing selective adenomectomy resulted in a 95% remission rate with low hypopituitarism risk (5%).
    • Subtotal or total hypophysectomy had lower remission rates (42%) and a higher risk of hypopituitarism (50%).

    Conclusions:

    • Repeat transsphenoidal exploration is a viable option for managing persistent or recurrent Cushing's disease.
    • Selective adenomectomy, when an adenoma is identified, offers high remission rates and minimal risk of hypopituitarism.
    • In cases where no adenoma is found, less targeted surgery increases the risk of hypopituitarism without guaranteeing remission.