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Updated: Jun 22, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Long-term outcomes in patients with Cushing's disease vs nonfunctioning pituitary adenoma after pituitary surgery: an
Sara Germann1, Roxana Wimmer1,2, Rahel Laager2
1University Department of Medicine, Clinic for Endocrinology, Diabetology, and Metabolism, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Insights
Patients with Cushing's disease (CD) face higher complication risks post-pituitary surgery compared to nonfunctioning pituitary adenoma (NFPA) patients. These risks include psychiatric hospitalizations and sepsis, indicating incomplete recovery.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Cushing's disease (CD) often leads to multisystem morbidity that may not fully resolve after treatment.
- Pituitary surgery is a primary treatment for CD, but long-term outcomes require further investigation.
Purpose of the Study:
- To compare the incidence of major complications in hospitalized patients with Cushing's disease (CD) versus nonfunctioning pituitary adenoma (NFPA) following pituitary surgery.
- To assess the long-term impact of CD on patient morbidity after surgical intervention.
Main Methods:
- A population-based retrospective cohort study utilized data from the Swiss Federal Statistical Office (2012-2021).
- Propensity score matching (1:5) compared hospitalized CD and NFPA patients undergoing pituitary surgery.
- The primary composite endpoint included mortality, major adverse cardiac events, psychiatric hospitalizations, sepsis, thromboembolic events, and fractures.
Main Results:
- 116 CD patients and 396 NFPA patients were analyzed post-surgery (median follow-up: 50.0 months).
- CD patients exhibited a significantly higher incidence rate of the primary composite endpoint (HR 2.75).
- Increased hospitalization rates for psychiatric disorders (HR 3.27) and a trend for sepsis were observed in CD patients.
Conclusions:
- Cushing's disease patients experience a substantially higher risk of severe complications post-pituitary surgery.
- Psychiatric hospitalizations and sepsis represent significant post-operative morbidities in CD patients.
- These findings highlight the need for vigilant monitoring and management of CD patients even after successful pituitary surgery.
Objective:
There is increasing evidence that multisystem morbidity in patients with Cushing's disease (CD) is only partially reversible following treatment. We investigated complications from multiple organs in hospitalized patients with CD compared to patients with nonfunctioning pituitary adenoma (NFPA) after pituitary surgery.
Design:
Population-based retrospective cohort study using data from the Swiss Federal Statistical Office between January 2012 and December 2021.
Methods:
Through 1:5 propensity score matching, we compared hospitalized patients undergoing pituitary surgery for CD or NFPA, addressing demographic differences. The primary composite endpoint included all-cause mortality, major adverse cardiac events (ie, myocardial infarction, unstable angina, heart failure, cardiac arrest, and ischemic stroke), hospitalization for psychiatric disorders, sepsis, severe thromboembolic events, and fractures in need of hospitalization. Secondary endpoints comprised individual components of the primary endpoint and surgical reintervention due to disease persistence or recurrence.
Results:
After matching, 116 patients with CD (mean age 45.4 years [SD, 14.4], 75.0% female) and 396 with NFPA (47.3 years [14.3], 69.7% female) were included and followed for a median time of 50.0 months (IQR 23.5, 82.0) after pituitary surgery. Cushing's disease presence was associated with a higher incidence rate of the primary endpoint (40.6 vs 15.7 events per 1000 person-years, hazard ratio [HR] 2.75; 95% CI, 1.54-4.90). Cushing's disease patients also showed increased hospitalization rates for psychiatric disorders (HR 3.27; 95% CI, 1.59-6.71) and a trend for sepsis (HR 3.15; 95% CI, .95-10.40).
Conclusions:
Even after pituitary surgery, CD patients faced a higher hazard of complications, especially psychiatric hospitalizations and sepsis.
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