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Prediction of remission and recurrence of Cushing's disease following transsphenoidal surgery (TSS): a single center, 20-year, retrospective series

  • 0Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Endocrine +

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June 18, 2025

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June 18, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Transsphenoidal surgery for Cushing's disease shows a 63.9% remission rate. Glucocorticoid withdrawal syndrome may protect against recurrence, challenging prior assumptions about microadenomas.

Area Of Science

  • Endocrinology
  • Neurosurgery
  • Oncology

Background

  • Cushing's disease (CD) is a rare endocrine disorder caused by excess cortisol.
  • Transsphenoidal surgery (TSS) is a primary treatment for CD, but outcomes vary.
  • Predicting surgical success in CD remains a clinical challenge.

Purpose Of The Study

  • To evaluate remission and recurrence rates after TSS for Cushing's disease in Israel.
  • To identify factors predicting surgical remission and recurrence.
  • To test the hypothesis that microadenomas have higher remission rates than macroadenomas.

Main Methods

  • Retrospective analysis of 97 CD patients undergoing TSS (2002-2022).
  • Remission defined by biochemical and clinical criteria.
  • Recurrence assessed via dexamethasone suppression tests and urinary free cortisol.
  • Statistical analyses included univariate, multivariate, Kaplan-Meier, and Cox proportional hazard models.

Main Results

  • Overall remission rate was 63.9%, with no significant difference between microadenomas and macroadenomas.
  • Predictors of remission included positive adenoma pathology (OR=31.25) and first-time surgery (OR=9.42).
  • Relapse rate was 22.6%; glucocorticoid withdrawal syndrome was a novel protective factor against recurrence (P=0.045).

Conclusions

  • TSS outcomes for CD in Israel challenge existing remission predictors, including microadenoma size.
  • Glucocorticoid withdrawal syndrome is a novel predictor of long-term remission.
  • Findings offer insights for post-operative monitoring in Cushing's disease management.

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