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Updated: Oct 1, 2025

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Cushing Disease: Medical and Surgical Considerations.

David P Bray1, Rima S Rindler1, Reem A Dawoud2

  • 1Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA.

Otolaryngologic Clinics of North America
|March 8, 2022
PubMed
Summary

Cushing disease, caused by excess adrenocorticotropic hormone from pituitary tumors, presents unique diagnostic challenges. Surgical removal of the adenoma offers a cure, but ongoing monitoring for deficiencies and recurrence is essential.

Keywords:
AdenomaCushing diseaseEndonasalEndoscopicPituitarySkull baseTransnasal

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Area of Science:

  • Endocrinology
  • Oncology
  • Neurosurgery

Background:

  • Cushing disease results from excess adrenocorticotropic hormone (ACTH) due to pituitary adenomas, leading to hypercortisolemia.
  • It is a rare condition with characteristic but often difficult-to-diagnose clinical signs and symptoms.

Purpose of the Study:

  • To summarize the diagnostic and therapeutic strategies for Cushing disease.
  • To highlight the importance of surgical intervention and long-term patient management.

Main Methods:

  • Review of clinical presentation, diagnostic endocrinologic assays, and neuroradiologic investigations.
  • Discussion of surgical resection as the primary treatment modality.
  • Outline of alternative treatments and follow-up protocols.

Main Results:

  • Surgical resection of ACTH-secreting pituitary adenomas is the gold standard and curative treatment.
  • Diagnosis often requires multiple, varied tests due to subtle clinical manifestations.
  • Post-surgical care involves managing neuroendocrine deficiencies and monitoring for recurrence.

Conclusions:

  • Cushing disease necessitates a comprehensive diagnostic approach and effective surgical treatment.
  • Long-term endocrinologic follow-up is crucial for patient well-being and disease surveillance.
  • Alternative therapies exist for cases where surgery is not fully successful or feasible.