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Related Concept Videos

Cushing Syndrome I: Introduction01:26

Cushing Syndrome I: Introduction

Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...
Cushing Syndrome II: Pathophysiology01:19

Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...

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Related Experiment Video

Updated: Jul 3, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Reoperation for Recurrent and Persistent Cushing's Disease without Visible MRI Findings.

Baofeng Wang1, Shuying Zheng1, Jie Ren1

  • 1Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.

Journal of Clinical Medicine
|November 26, 2022
PubMed
Summary

Repeat surgery for Cushing's disease (CD) offers reasonable remission rates, regardless of magnetic resonance imaging (MRI) findings. Negative MRI results do not definitively predict failed reoperations for persistent hypercortisolism.

Keywords:
Cushing’s diseaseMRIpersistencerecurrencerepeat surgery

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Area of Science:

  • Neurosurgery
  • Endocrinology
  • Radiology

Background:

  • Transsphenoidal surgery is the primary treatment for Cushing's disease (CD).
  • Some patients experience persistent or recurrent hypercortisolism despite initial surgery, sometimes with negative preoperative magnetic resonance imaging (MRI) findings.
  • Repeat surgery is considered for these cases, but its efficacy, particularly concerning MRI findings, requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of repeat transsphenoidal surgery in patients with Cushing's disease (CD).
  • To compare outcomes between patients with positive and negative MRI findings before repeat surgery.
  • To determine if positive MRI findings are associated with early remission after repeat surgery.

Main Methods:

  • Retrospective analysis of clinical, imaging, and biochemical data from 42 patients undergoing repeat surgery for CD.
  • Comparison of endocrinological, histopathological, and surgical outcomes between 14 patients with negative MRI findings and 28 patients with positive MRI findings.
  • Analysis of remission rates based on disease persistence or recurrence and MRI findings.

Main Results:

  • Immediate remission was achieved in 69.0% of patients following repeat surgery.
  • MRI findings suggestive of solid lesions were present in 66.7% of all patients.
  • Remission rates did not significantly differ between recurrence and persistence groups (77.8% vs. 57.1%).
  • Positive MRI findings were not significantly associated with remission after repeat surgery (OR = 3.667).

Conclusions:

  • Repeat surgery demonstrates reasonable remission rates for Cushing's disease (CD) recurrence, irrespective of MRI findings.
  • Repeat surgery remains a viable option for persistent CD with positive MRI findings.
  • Further research is needed to ascertain if negative MRI findings predict unsuccessful reoperations for persistent hypercortisolism.