Persistent Cushing's Disease after Transsphenoidal Surgery: Challenges and Solutions.

Area of Science:

• Endocrinology
• Neurosurgery
• Oncology

Background:

• Cushing's disease (CD) is primarily treated with transsphenoidal surgery.
• Despite surgical advancements, persistent hypercortisolism occurs in approximately 22% of CD patients due to incomplete tumor resection.
• Misdiagnosis, including ectopic ACTH secretion or pseudo-Cushing, can also lead to treatment failure.

Purpose of the Study:

• To analyze predictive factors for remission or persistence of CD after pituitary surgery.
• To review therapeutic options for patients with persistent hypercortisolism post-surgery.
• To emphasize a multidisciplinary approach for optimizing diagnosis and treatment outcomes in CD.

Main Methods:

• Literature review focusing on factors predicting surgical success in Cushing's disease.
• Analysis of diagnostic challenges, including ectopic ACTH secretion and pseudo-Cushing.
• Evaluation of treatment strategies for persistent hypercortisolism after transsphenoidal surgery.

Main Results:

• Incomplete tumor resection is a significant cause of persistent hypercortisolism.
• Diagnostic errors can contribute to treatment failure in Cushing's disease.
• Predictive factors for remission and persistence require further investigation.

Conclusions:

• A multidisciplinary approach is crucial for accurate diagnosis and management of Cushing's disease.
• Identifying predictors of surgical outcomes can guide personalized treatment strategies.
• Effective management of surgical failure is essential to improve patient morbidity and mortality.